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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77232.42,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61598.44,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103260.95,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43249.34,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64086.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"minimum":34500.66,"maximum":34500.66,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34500.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"minimum":25415.86,"maximum":25415.86,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25415.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"minimum":16839.5,"maximum":16839.5,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16839.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Chemothera","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"minimum":36233.16,"maximum":98447.21,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":98447.21,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36233.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"minimum":7826.69,"maximum":32876.92,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14265.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26586.98,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7826.69,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32876.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"minimum":19346.4,"maximum":50958.69,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19948.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50958.69,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19346.4,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19719.32,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19941.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"minimum":15821.28,"maximum":15821.28,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15821.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"minimum":1632.0,"maximum":1632.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1632.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"minimum":6199.36,"maximum":59157.02,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23026.69,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59157.02,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23265.97,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6199.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"minimum":67746.56,"maximum":67746.56,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67746.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"minimum":12883.82,"maximum":21068.66,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21068.66,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14835.28,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14942.89,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12883.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"minimum":1565.34,"maximum":29656.1,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12582.13,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29656.1,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12340.97,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7665.84,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11134.71,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1565.34,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16589.19,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16210.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"minimum":9618.25,"maximum":45887.24,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45887.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9618.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"minimum":10785.92,"maximum":11363.87,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11363.87,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10785.92,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11246.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"minimum":6797.11,"maximum":17987.1,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8244.4,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8303.13,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17987.1,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17006.71,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6797.11,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8599.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"minimum":8688.92,"maximum":25623.02,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25623.02,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8688.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"minimum":15280.44,"maximum":15280.44,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15280.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"minimum":1423.04,"maximum":1423.04,"setting":"inpatient","payers_information":[{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1423.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"minimum":12113.59,"maximum":14449.25,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14449.25,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12113.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"minimum":5768.48,"maximum":5768.48,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5768.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"minimum":5636.36,"maximum":25868.47,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13255.51,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25868.47,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10451.39,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24306.63,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9429.88,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5636.36,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18499.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"minimum":1404.27,"maximum":18546.99,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12149.29,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18546.99,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9712.86,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1404.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"minimum":2208.4,"maximum":86436.0,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25221.86,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18663.11,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21433.18,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12263.26,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3826.77,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":65389.0,"methodology":"other"},{"payer_name":"Manhattan Life","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2208.4,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13344.92,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11267.54,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33428.14,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3401.48,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18710.78,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2944.98,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37149.74,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9068.41,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33231.56,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9150.61,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20566.0,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8290.59,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17311.77,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":86436.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28812.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10454.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"minimum":5207.34,"maximum":5207.34,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5207.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"minimum":17581.79,"maximum":17581.79,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17581.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"minimum":4649.52,"maximum":11289.18,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11289.18,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"minimum":2403.62,"maximum":34563.77,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12387.55,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9586.05,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34323.91,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6999.90,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34563.77,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13575.61,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22939.15,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13986.91,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7136.91,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2403.62,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9876.98,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14825.04,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7994.53,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13951.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"minimum":1484.13,"maximum":18590.26,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7912.52,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9143.47,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1484.13,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4625.72,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11664.5,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16097.49,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6936.93,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18590.26,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7665.84,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5987.06,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2181.32,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5636.37,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4269.12,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5420.18,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8818.86,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8158.74,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8148.32,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1692.63,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13407.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"minimum":1549.84,"maximum":10273.32,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3844.17,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5597.84,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6184.7,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10273.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3848.82,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2113.64,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.84,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4269.12,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3471.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nonspecific Cva And Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"minimum":8370.84,"maximum":8590.8,"setting":"inpatient","payers_information":[{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8370.84,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8590.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nonspecific Cva And Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"minimum":5038.84,"maximum":13902.22,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13902.22,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5038.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"minimum":3130.68,"maximum":13782.37,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13782.37,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5181.04,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8296.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nonspecific Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"minimum":9515.4,"maximum":16098.23,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16098.23,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9515.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nonspecific Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"minimum":4516.0,"maximum":12556.26,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8323.1,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6387.36,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4613.24,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4516.0,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12556.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nonspecific Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"minimum":5285.71,"maximum":6209.48,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5285.71,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6209.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"minimum":9068.41,"maximum":10814.9,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10814.9,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9068.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"minimum":3099.68,"maximum":31785.6,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15044.12,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7957.65,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4696.02,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4960.34,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31785.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"minimum":20847.93,"maximum":20847.93,"setting":"inpatient","payers_information":[{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20847.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"minimum":1409.09,"maximum":11418.66,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11418.66,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"minimum":15171.11,"maximum":15337.78,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15171.11,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15337.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"minimum":6197.02,"maximum":6197.02,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6197.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"minimum":14711.52,"maximum":32145.8,"setting":"inpatient","payers_information":[{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32145.8,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29352.22,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14711.52,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16991.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"minimum":4247.57,"maximum":66966.72,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8768.41,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4946.43,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66966.72,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4247.57,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7787.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"minimum":3161.68,"maximum":7748.97,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5355.30,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6886.87,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3161.68,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7748.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"minimum":5580.56,"maximum":15569.95,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10817.29,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15569.95,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13166.79,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14147.44,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9197.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"minimum":2051.2,"maximum":19339.22,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9445.87,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19339.22,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7462.27,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7941.98,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2051.2,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4799.75,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4882.99,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5405.34,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9376.57,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9848.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"minimum":5140.6,"maximum":8284.99,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6843.95,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7972.19,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8284.99,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5140.6,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7091.64,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6969.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"minimum":8633.87,"maximum":16095.51,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12989.18,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16095.51,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8633.87,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12598.4,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11796.92,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9381.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"minimum":2846.08,"maximum":12419.91,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3142.21,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6043.18,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7581.73,"methodology":"other"},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8229.5,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2846.08,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9068.41,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12419.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"minimum":4746.7,"maximum":11187.37,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11187.37,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4746.7,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6249.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"minimum":23612.75,"maximum":63173.97,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":63173.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23612.75,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27902.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"minimum":9299.04,"maximum":9299.04,"setting":"inpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9299.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"minimum":13349.74,"maximum":13349.74,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13349.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"minimum":1225.0,"maximum":62758.35,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62758.35,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1225.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"minimum":11021.30,"maximum":19515.14,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19515.14,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11021.30,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"minimum":7912.94,"maximum":18136.82,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7912.94,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18136.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"minimum":1475.0,"maximum":18387.38,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1475.0,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18387.38,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18387.38,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11656.57,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12446.12,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7963.53,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12210.21,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5636.36,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4742.52,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6199.36,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8116.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"minimum":1580.84,"maximum":27028.74,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27028.74,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8182.71,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15904.86,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4132.88,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15696.06,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6289.92,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5292.75,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1851.07,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5636.36,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11161.12,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1580.84,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3169.28,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10793.12,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6873.91,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11008.8,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9652.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"minimum":3886.88,"maximum":14536.45,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6800.33,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11309.16,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3886.88,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14536.45,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5148.5,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"minimum":5656.26,"maximum":10677.03,"setting":"inpatient","payers_information":[{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10677.03,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5656.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"minimum":12880.99,"maximum":12880.99,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12880.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"minimum":4722.32,"maximum":4722.32,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4722.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"minimum":9572.53,"maximum":9572.53,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9572.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"minimum":3603.58,"maximum":19531.96,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3603.58,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6098.64,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19531.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"minimum":17931.45,"maximum":17931.45,"setting":"inpatient","payers_information":[{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17931.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"minimum":23941.39,"maximum":29490.87,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23941.39,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29490.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":15344.17,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14290.37,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12840.74,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10913.75,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15344.17,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14283.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"minimum":9487.55,"maximum":24646.93,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13898.71,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24646.93,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9487.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"minimum":4828.33,"maximum":13493.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4828.33,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11212.01,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13493.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"minimum":1549.84,"maximum":7317.86,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7274.73,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7317.86,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.84,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3161.68,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6609.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"minimum":4185.42,"maximum":16300.72,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16300.72,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"minimum":1854.90,"maximum":4470.9,"setting":"inpatient","payers_information":[{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1854.90,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4470.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"minimum":7043.93,"maximum":9803.86,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7920.61,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7043.93,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9803.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"minimum":2996.46,"maximum":6169.9,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5944.25,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6169.9,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2996.46,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"minimum":8735.97,"maximum":8735.97,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8735.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"minimum":1549.84,"maximum":5015.01,"setting":"inpatient","payers_information":[{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5015.01,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4156.34,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.84,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1840.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"minimum":1409.09,"maximum":11760.81,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11760.81,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7074.89,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.09,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"minimum":3640.8,"maximum":5184.02,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3640.8,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5184.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"minimum":9299.04,"maximum":9299.04,"setting":"inpatient","payers_information":[{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9299.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"minimum":3576.06,"maximum":44870.62,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44870.62,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6630.61,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3576.06,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18136.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"minimum":4649.52,"maximum":8296.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5619.43,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8296.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"minimum":1770.0,"maximum":81337.88,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31945.64,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1784.4,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1770.0,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49056.9,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81337.88,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":69955.89,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29268.41,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30023.22,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33170.37,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66788.61,"methodology":"other"},{"payer_name":"Va Visn 16","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29991.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"minimum":9194.18,"maximum":47683.24,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43747.9,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17369.96,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23124.54,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15959.88,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10463.55,"methodology":"other"},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47683.24,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9194.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"minimum":11837.45,"maximum":11837.45,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11837.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"minimum":13951.4,"maximum":28183.08,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26992.27,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25759.75,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13951.4,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27491.03,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28183.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"minimum":11210.11,"maximum":19645.74,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19645.74,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11210.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"minimum":8162.66,"maximum":23393.96,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23393.96,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8162.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"minimum":1409.09,"maximum":37219.8,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31474.08,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.09,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37219.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"minimum":1340.0,"maximum":24368.8,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9457.54,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13050.75,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9992.93,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24368.8,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8020.18,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10075.18,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10001.07,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1340.0,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10070.11,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9976.05,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2153.52,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6325.27,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15658.88,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10870.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"minimum":3099.68,"maximum":12251.48,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6226.27,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12251.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4681.63,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4601.97,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6611.76,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9872.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"minimum":3130.68,"maximum":27894.32,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10335.76,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12091.31,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12031.90,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15260.73,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11836.9,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27894.32,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22506.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10407.89,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11811.89,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10436.10,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4516.0,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12886.26,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6199.36,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10441.22,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11903.30,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12084.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"minimum":1429.5,"maximum":144977.24,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5765.15,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7956.87,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11451.03,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3313.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7099.59,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1429.5,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4696.02,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12807.36,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8834.94,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3194.36,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":144977.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"minimum":1180.98,"maximum":15346.54,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4326.42,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4336.45,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1180.98,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.84,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15346.54,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2294.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"minimum":11070.79,"maximum":30630.38,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12314.32,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30158.31,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30630.38,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11070.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"minimum":3311.16,"maximum":8221.78,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8044.99,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3311.16,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4931.82,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8221.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"minimum":4851.68,"maximum":6111.34,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6111.34,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4851.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"minimum":9615.39,"maximum":11458.99,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9615.39,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11458.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"minimum":6217.85,"maximum":16254.42,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9462.82,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16254.42,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7745.75,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15841.58,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7179.22,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6217.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"minimum":5924.21,"maximum":5924.21,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5924.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"minimum":1808.0,"maximum":11960.36,"setting":"inpatient","payers_information":[{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6604.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9469.75,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11960.36,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6261.35,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5587.95,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1808.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"minimum":1440.0,"maximum":17192.15,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17192.15,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7240.0,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7155.87,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7904.2,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1440.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"minimum":2200.63,"maximum":12881.6,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12881.6,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2200.63,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9765.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"minimum":1109.2,"maximum":17104.24,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7703.2,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11655.61,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9250.12,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11659.06,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17104.24,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1835.24,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5903.41,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8324.06,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4169.27,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4681.96,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2974.43,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7917.25,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1109.2,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4732.92,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8944.92,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9325.35,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14912.13,"methodology":"other"},{"payer_name":"Va Visn 16","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9222.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"minimum":1475.68,"maximum":13338.61,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6507.7,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8142.46,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4333.61,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11266.96,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6141.33,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6948.42,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1475.68,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4236.42,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2846.08,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8370.84,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7585.48,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4993.85,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4242.18,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9101.12,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13338.61,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8590.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"minimum":1786.0,"maximum":77581.14,"setting":"inpatient","payers_information":[{"payer_name":"Ar Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1786.0,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2134.35,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77581.14,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6492.37,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4367.80,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6851.13,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6199.36,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3859.29,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6515.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.28,"maximum":5528.77,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5105.61,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5260.6,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4424.44,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3547.38,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5195.38,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5097.67,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5528.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"minimum":4185.42,"maximum":22738.23,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10105.88,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5509.98,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11934.01,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6982.06,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13585.71,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22738.23,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16809.0,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4645.34,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5700.15,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8233.03,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9149.07,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7720.62,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7523.17,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13548.0,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15653.44,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6199.36,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8001.7,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9842.40,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16057.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"minimum":2121.28,"maximum":13375.89,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6907.08,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13375.89,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2121.28,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4724.54,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6355.19,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3583.17,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4227.27,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7115.2,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3858.16,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3941.14,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3941.14,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6422.39,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10186.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"minimum":3130.68,"maximum":10848.88,"setting":"inpatient","payers_information":[{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10795.35,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5021.85,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7402.14,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4269.72,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4613.7,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3446.4,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3642.55,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3794.3,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4340.12,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10848.88,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4444.31,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7572.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"minimum":9299.04,"maximum":11970.08,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11970.08,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9299.04,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9411.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"minimum":5755.74,"maximum":5755.74,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5755.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"minimum":10757.07,"maximum":21367.19,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12676.38,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21367.19,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10757.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"minimum":4449.45,"maximum":7913.94,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7913.94,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7894.03,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6377.38,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6975.7,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4449.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"minimum":3964.96,"maximum":12556.26,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11684.04,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3964.96,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7045.46,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12556.26,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4516.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":16681.38,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8220.51,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16681.38,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3619.98,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5604.16,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3799.69,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10174.7,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6975.7,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2846.08,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5124.07,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13279.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"minimum":1472.49,"maximum":9286.60,"setting":"inpatient","payers_information":[{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4917.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9286.60,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3645.40,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4696.02,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1472.49,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3161.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"minimum":2896.30,"maximum":9960.38,"setting":"inpatient","payers_information":[{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2896.30,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5636.7,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9960.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"minimum":1409.09,"maximum":8415.46,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8415.46,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.09,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"minimum":4185.42,"maximum":7111.9,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6911.26,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4696.02,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7111.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"minimum":21940.98,"maximum":62710.8,"setting":"inpatient","payers_information":[{"payer_name":"All Savers Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62710.8,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21940.98,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45365.44,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45199.51,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29883.84,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22010.0,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41076.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"minimum":5244.32,"maximum":34743.51,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18300.34,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18365.82,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15317.52,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24323.21,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12403.68,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32014.47,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8587.80,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34743.51,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16957.17,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18513.72,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19072.41,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18131.05,"methodology":"other"},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16753.89,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5244.32,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8335.38,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16131.67,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18342.9,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19952.62,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9691.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"minimum":14507.8,"maximum":176266.59,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":176266.59,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":176266.59,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":65718.28,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56133.87,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14507.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"minimum":9299.04,"maximum":73815.03,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":63197.13,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":63545.62,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49074.67,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9299.04,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73815.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"minimum":1011.44,"maximum":42147.59,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42147.59,"methodology":"other"},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1011.44,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34280.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"minimum":8296.0,"maximum":8296.0,"setting":"inpatient","payers_information":[{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8296.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"minimum":43670.79,"maximum":52222.27,"setting":"inpatient","payers_information":[{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43670.79,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52222.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"minimum":10957.37,"maximum":90500.82,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90500.82,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36886.81,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10957.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"minimum":30921.87,"maximum":30921.87,"setting":"inpatient","payers_information":[{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30921.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"minimum":1761.36,"maximum":33736.13,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33332.47,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33314.77,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33428.73,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1761.36,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33694.1,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33736.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"minimum":10809.17,"maximum":54867.18,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54867.18,"methodology":"other"},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21682.42,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19402.33,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21422.59,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21258.58,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10809.17,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21398.83,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11444.40,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"minimum":39526.88,"maximum":102861.04,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":102861.04,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39843.59,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39526.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"minimum":14092.38,"maximum":136022.42,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70164.7,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136022.42,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49155.91,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43590.64,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14092.38,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30327.98,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15500.0,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76002.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"minimum":12646.72,"maximum":63637.78,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46759.96,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49840.78,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33159.66,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18271.36,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12646.72,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17439.25,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":63637.78,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60967.44,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26710.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"minimum":37610.11,"maximum":81306.59,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58378.12,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81306.59,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71913.44,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37610.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"minimum":24433.39,"maximum":55930.28,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28266.45,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25624.44,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24433.39,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55930.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"minimum":19285.68,"maximum":45117.4,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45117.4,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21364.98,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31412.54,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19285.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"minimum":4185.42,"maximum":25271.38,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19042.24,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25271.38,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17642.4,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18839.71,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"minimum":6199.36,"maximum":6199.36,"setting":"inpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6199.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"minimum":21471.21,"maximum":58532.35,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23815.52,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58532.35,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21471.21,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22633.42,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23120.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"minimum":2748.35,"maximum":15591.61,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2748.35,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15591.61,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8450.70,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"minimum":12898.98,"maximum":12898.98,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12898.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"minimum":9299.04,"maximum":9299.04,"setting":"inpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9299.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"minimum":10822.4,"maximum":10822.4,"setting":"inpatient","payers_information":[{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10822.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"minimum":12711.06,"maximum":12711.06,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12711.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"minimum":1580.84,"maximum":15908.17,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14662.24,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15908.17,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1580.84,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12761.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"minimum":2818.18,"maximum":14275.66,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11263.8,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14275.66,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9695.98,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2818.18,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11677.50,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"minimum":1069.34,"maximum":23691.28,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22501.83,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23044.51,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20814.75,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22216.41,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22714.99,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.09,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1069.34,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21783.82,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23691.28,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23659.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"minimum":2258.0,"maximum":41215.49,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18257.98,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22949.53,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8789.75,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41215.49,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15964.43,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17312.5,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2258.0,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8446.77,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14385.04,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25840.56,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17971.37,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18118.75,"methodology":"other"},{"payer_name":"Va Visn 16","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18242.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"minimum":1111.0,"maximum":41643.79,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12107.88,"methodology":"other"},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10659.47,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15608.84,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15608.84,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41643.79,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10153.73,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10659.47,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1111.0,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"minimum":14722.37,"maximum":16066.15,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16066.15,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14722.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"minimum":4269.12,"maximum":14750.63,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14750.63,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9444.69,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11517.42,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4269.12,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11934.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"minimum":12870.92,"maximum":12870.92,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12870.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"minimum":20909.52,"maximum":29823.34,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29823.34,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20909.52,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23797.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"minimum":10070.08,"maximum":10070.08,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10070.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"minimum":9687.21,"maximum":41383.0,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22391.87,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22034.63,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41383.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20612.13,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21738.53,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9687.21,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17590.72,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22823.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"minimum":22545.46,"maximum":107782.7,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":107782.7,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41543.31,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32091.37,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41004.2,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22545.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"minimum":16299.37,"maximum":110791.29,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32001.36,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32286.94,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30304.49,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31106.32,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31904.48,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16299.37,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32264.5,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110791.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"minimum":43896.45,"maximum":90348.04,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66469.55,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43896.45,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90348.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"minimum":2846.08,"maximum":36427.14,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27644.38,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26415.07,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2846.08,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36427.14,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27739.48,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14706.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"minimum":1005.0,"maximum":87667.00,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31977.95,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34370.94,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33243.7,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48637.47,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87667.00,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31471.55,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22465.17,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32255.08,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1005.0,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17027.52,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15915.56,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6406.73,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20692.21,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4262.77,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35556.84,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38800.42,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31313.9,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41400.99,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64294.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"minimum":1409.09,"maximum":88647.91,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31436.57,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23107.54,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":88647.91,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2157.38,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21848.66,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23135.56,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.09,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1764.0,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22952.69,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33462.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"minimum":4185.42,"maximum":36995.11,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16617.73,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28427.33,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15635.3,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36995.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"minimum":23962.33,"maximum":26721.94,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26721.94,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24687.94,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23962.33,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24843.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"minimum":19152.55,"maximum":28484.93,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20131.01,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21570.25,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28484.93,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21760.17,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20448.28,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21549.14,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21737.72,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21624.90,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21659.45,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22198.64,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19152.55,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26195.34,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21776.63,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22399.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"minimum":6975.7,"maximum":48413.08,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48413.08,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45808.31,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7826.7,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6975.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.28,"maximum":55866.54,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55866.54,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40767.78,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"minimum":30231.76,"maximum":31675.43,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31675.43,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30231.76,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31625.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"minimum":32550.26,"maximum":34886.12,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32550.26,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34886.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"minimum":4696.02,"maximum":21939.36,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21524.46,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21764.6,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4696.02,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21939.36,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9262.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"minimum":5297.78,"maximum":23239.00,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11172.92,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11875.08,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10702.41,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23239.00,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9682.63,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10368.77,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8789.38,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8954.82,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6323.36,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8973.26,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5297.78,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6887.12,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10748.07,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12028.94,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13121.44,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19203.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"minimum":2841.76,"maximum":15906.58,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7185.36,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8213.28,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11939.2,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7021.98,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15906.58,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3738.74,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5314.84,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2841.76,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7230.55,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5830.82,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3161.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4679.47,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4757.58,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11050.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"minimum":2819.84,"maximum":11235.48,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5650.41,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11235.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4047.77,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2819.84,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5812.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"minimum":6975.7,"maximum":14142.42,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13635.11,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12195.7,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8869.37,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6975.7,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14142.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"minimum":6380.0,"maximum":6380.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6380.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"minimum":3566.58,"maximum":33151.25,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15672.09,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3590.65,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19391.65,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18708.83,"methodology":"other"},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13293.07,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32861.02,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30909.23,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33151.25,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14405.16,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13393.23,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3566.58,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14812.33,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7430.8,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7749.2,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10294.67,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4981.29,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17095.58,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15124.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.28,"maximum":18156.39,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4759.64,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7925.77,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9730.01,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10265.62,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18042.7,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7923.73,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10739.77,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18156.39,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7381.92,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13091.69,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9966.56,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6410.95,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8584.11,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5696.98,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3642.55,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8371.47,"methodology":"other"},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12071.74,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8397.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13091.69,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10896.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"minimum":1148.36,"maximum":21289.56,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9385.58,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11549.87,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2131.95,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21289.56,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16855.55,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8762.62,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6720.23,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6885.06,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8671.89,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8147.92,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4664.14,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9850.32,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1148.36,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11290.0,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8454.55,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4742.52,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8406.50,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8671.89,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8147.92,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9349.43,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8421.12,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9664.43,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15540.33,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15899.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":14860.87,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6688.14,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8428.79,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14860.87,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11851.99,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4515.27,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5221.07,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4269.12,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4515.27,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4125.59,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5360.7,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10367.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"minimum":10070.05,"maximum":64280.83,"setting":"inpatient","payers_information":[{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64280.83,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10070.05,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"minimum":1565.34,"maximum":27078.72,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2198.18,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27078.72,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12330.44,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11215.1,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1565.34,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9626.42,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17471.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"minimum":1667.68,"maximum":12914.97,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5397.89,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10927.15,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5181.54,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6308.8,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1667.68,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7486.68,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5006.24,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12914.97,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8402.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"minimum":1565.34,"maximum":10453.2,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10453.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4633.88,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1565.34,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4742.52,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4340.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":3831.77,"setting":"inpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3831.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"minimum":2347.87,"maximum":9284.76,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9284.76,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5203.47,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3840.54,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2347.87,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3240.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"minimum":1409.09,"maximum":24180.71,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10336.33,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16320.34,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16392.16,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24180.71,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6384.6,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7337.27,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5841.06,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8469.24,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.09,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7749.2,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6323.36,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4957.88,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3440.09,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4353.90,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"minimum":1100.0,"maximum":12428.03,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5826.07,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1677.25,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6778.45,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12428.03,"methodology":"other"},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8960.41,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1100.0,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7687.92,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8117.34,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6787.65,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4277.92,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5833.62,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2092.71,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4584.72,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.84,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3452.92,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5814.27,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2196.1,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3156.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"minimum":5507.29,"maximum":7563.56,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5507.29,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7563.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"minimum":1732.54,"maximum":115008.31,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8924.32,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10814.91,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19012.46,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13013.0,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5663.69,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115008.31,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7495.37,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2010.0,"methodology":"other"},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1732.54,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7659.0,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5636.36,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4494.82,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8514.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"minimum":2131.95,"maximum":12850.54,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4206.61,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5986.05,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6699.26,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2367.46,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11741.24,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5082.58,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3801.43,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3227.91,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4220.69,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2131.95,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12850.54,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7115.2,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4340.12,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5880.34,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3227.91,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4206.61,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5762.74,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8948.49,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5993.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"minimum":2972.05,"maximum":9654.73,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4508.54,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4529.68,"methodology":"other"},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2972.05,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9654.73,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8435.7,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2974.42,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4523.78,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4743.64,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6693.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"minimum":3913.01,"maximum":3913.01,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3913.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"minimum":1085.30,"maximum":15035.15,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6626.19,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15035.15,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6531.18,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14900.56,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4993.03,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1123.84,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1085.30,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5372.7,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3485.12,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6726.34,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6789.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":6509.46,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4853.41,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5627.27,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6509.46,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3563.44,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2078.49,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4083.52,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1565.34,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4269.12,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2324.76,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5754.31,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3029.15,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3172.90,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"minimum":4222.14,"maximum":55161.54,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14459.29,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4222.14,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36125.44,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55161.54,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12989.49,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15269.28,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15653.39,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12028.08,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11541.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"minimum":2099.68,"maximum":11136.14,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2979.62,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6601.82,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4980.84,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2099.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7263.94,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8217.98,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11136.14,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8696.82,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2460.11,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7956.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"minimum":1409.09,"maximum":8384.44,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7080.58,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5642.7,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.09,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8384.44,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5643.82,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4701.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"minimum":1472.49,"maximum":92085.78,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19830.17,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20912.18,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25860.61,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43273.71,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19422.37,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37252.2,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47975.96,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92085.78,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73819.52,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17346.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18068.2,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9840.48,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9783.78,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12660.86,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19728.68,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10022.07,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18138.70,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17218.72,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1472.49,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19431.77,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18636.4,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38666.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"minimum":2818.18,"maximum":51909.24,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11475.9,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6634.92,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12887.40,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16403.18,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16403.18,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29184.67,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12681.49,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18673.44,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28540.22,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51909.24,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30958.15,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10980.9,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11233.51,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12649.06,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12836.32,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5702.02,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2818.18,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10980.9,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10980.9,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11381.66,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17006.53,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12802.83,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11742.8,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19739.68,"methodology":"other"},{"payer_name":"Va Visn 16","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13336.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"minimum":22184.88,"maximum":27332.9,"setting":"inpatient","payers_information":[{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27332.9,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26266.11,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23247.6,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22184.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"minimum":18678.68,"maximum":22751.9,"setting":"inpatient","payers_information":[{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20128.95,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20989.86,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18678.68,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20043.57,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22751.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"minimum":14169.94,"maximum":14169.94,"setting":"inpatient","payers_information":[{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14169.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"minimum":4269.12,"maximum":268766.95,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23362.48,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":268766.95,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10001.94,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37506.43,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33049.74,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33594.41,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4269.12,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8060.02,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31340.6,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36635.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"minimum":4227.27,"maximum":40627.67,"setting":"inpatient","payers_information":[{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4227.27,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40627.67,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14991.67,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16313.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"minimum":4943.18,"maximum":39472.7,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39472.7,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4943.18,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25985.53,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11678.54,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13213.54,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19333.72,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15768.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"minimum":1225.0,"maximum":77941.9,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29874.11,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42529.09,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43424.64,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77941.9,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24640.56,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28743.78,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11900.7,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1225.0,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11355.64,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31489.83,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12400.14,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39301.86,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61772.06,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61381.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"minimum":1546.13,"maximum":40751.87,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16225.3,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21339.24,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40751.87,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14800.7,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1546.13,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2736.62,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13892.24,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15906.35,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7686.50,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7826.69,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4269.12,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11779.92,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11346.61,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34179.5,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34625.86,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28711.9,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30927.54,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17368.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"minimum":3161.68,"maximum":28852.03,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11895.61,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12043.71,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28852.03,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17122.95,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28738.24,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8667.92,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10249.25,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11691.38,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3161.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6199.36,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12459.8,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9524.8,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24495.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"minimum":9814.33,"maximum":10483.2,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9814.33,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10483.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"minimum":22620.98,"maximum":32160.46,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32160.46,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22620.98,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24806.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"minimum":4185.42,"maximum":15113.26,"setting":"inpatient","payers_information":[{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4350.65,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13066.19,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5373.92,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15113.26,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8296.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"minimum":9047.68,"maximum":10595.12,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10595.12,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10518.85,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9047.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9102.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"minimum":17176.53,"maximum":17176.53,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17176.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"minimum":9273.54,"maximum":10860.97,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10860.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10147.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9273.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"minimum":5580.56,"maximum":21426.36,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21426.36,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18827.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"minimum":14719.46,"maximum":42341.73,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42341.73,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14719.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"minimum":16733.77,"maximum":16733.77,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16733.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"minimum":16838.4,"maximum":16838.4,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16838.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"minimum":10279.82,"maximum":10279.82,"setting":"inpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10279.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"minimum":1409.09,"maximum":17173.31,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6581.55,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17173.31,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8095.69,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"minimum":17785.48,"maximum":17785.48,"setting":"inpatient","payers_information":[{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17785.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"minimum":10535.34,"maximum":28344.12,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28344.12,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10535.34,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12002.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":20395.82,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12408.82,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4930.71,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20395.82,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10034.9,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8228.53,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7907.33,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6281.37,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9864.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"minimum":6975.7,"maximum":52922.43,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12195.91,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6975.7,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52922.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"minimum":15061.82,"maximum":28620.67,"setting":"inpatient","payers_information":[{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15061.82,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28620.67,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27258.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"minimum":2258.0,"maximum":16353.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2258.0,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16353.35,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7699.26,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6935.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"minimum":5580.56,"maximum":26333.32,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26333.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11718.59,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11918.43,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11604.24,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"minimum":3099.68,"maximum":10055.33,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10055.33,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4337.85,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6604.07,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5308.32,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7883.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"minimum":5438.19,"maximum":5438.19,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5438.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"minimum":2818.18,"maximum":12176.41,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12021.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11072.1,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12176.41,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2818.18,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11161.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"minimum":1423.04,"maximum":25841.06,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7682.58,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11938.48,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25841.06,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7024.97,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5169.75,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6254.96,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2292.22,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7045.46,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.84,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1423.04,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5735.26,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8409.64,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7033.17,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13892.97,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8128.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"minimum":2456.22,"maximum":4037.35,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2456.22,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4037.35,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"minimum":8985.74,"maximum":16011.44,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11075.90,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8985.74,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16011.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":27780.88,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20677.86,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6170.9,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8793.51,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8677.69,"methodology":"other"},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27780.88,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5106.0,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"minimum":5174.44,"maximum":15488.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15488.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5174.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"minimum":7439.8,"maximum":30893.42,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12487.14,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12788.21,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12458.05,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30893.42,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10507.98,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8702.43,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12605.54,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12449.34,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10935.03,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20349.4,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7439.8,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13277.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":30503.55,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7410.04,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7455.94,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10096.6,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15742.22,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30503.55,"methodology":"other"},{"payer_name":"Cox Health Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6714.44,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5921.84,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7434.25,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2113.64,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4269.12,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4494.32,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4494.32,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12702.93,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7579.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"minimum":2080.0,"maximum":5052.03,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5052.03,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3495.82,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2080.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"minimum":2579.63,"maximum":15818.96,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15818.96,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2579.63,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7299.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6724.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"minimum":4301.31,"maximum":4301.31,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4301.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"minimum":5974.11,"maximum":5974.11,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5974.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"minimum":10365.66,"maximum":11958.81,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10365.66,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11958.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"minimum":5689.23,"maximum":14682.04,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14682.04,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5689.23,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10848.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"minimum":3826.73,"maximum":5622.61,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3826.73,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Va Visn 16","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5622.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"minimum":3874.6,"maximum":23247.6,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23247.6,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6250.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10400.08,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6350.37,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11065.88,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3874.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"minimum":2324.76,"maximum":12503.86,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6103.02,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12503.86,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3655.47,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4556.8,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4600.95,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5408.04,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2324.76,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6619.57,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3236.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"minimum":1737.68,"maximum":6975.7,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4592.53,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1737.68,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6416.99,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3815.18,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3013.43,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3052.56,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6975.7,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4882.99,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6766.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"minimum":3161.68,"maximum":19032.68,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11599.78,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5105.44,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19032.68,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5110.56,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8013.97,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3215.92,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3161.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9765.98,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4695.38,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4830.30,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.28,"maximum":12402.92,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4470.02,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7003.24,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6049.75,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7067.2,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7067.2,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12402.92,"methodology":"other"},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4470.02,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4486.59,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5115.04,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3003.88,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2945.08,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9508.9,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8902.45,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3240.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"minimum":10697.28,"maximum":27975.82,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11361.52,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27975.82,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10697.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"minimum":1409.09,"maximum":13171.07,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9594.79,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5749.57,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.09,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.84,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4481.88,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4481.88,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7521.45,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13171.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"minimum":2904.73,"maximum":11173.26,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6631.05,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11173.26,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3737.88,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2904.73,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"minimum":4516.0,"maximum":21231.54,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21231.54,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15845.16,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10033.49,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4516.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19866.58,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20641.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":19207.65,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19207.65,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7600.71,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.09,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14320.96,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14247.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"minimum":14814.39,"maximum":18093.21,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14814.39,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18093.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"minimum":25177.33,"maximum":25177.33,"setting":"inpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25177.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"minimum":13123.19,"maximum":13123.19,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13123.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"minimum":24275.36,"maximum":24275.36,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24275.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"minimum":7749.2,"maximum":38454.29,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38454.29,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33048.26,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14833.30,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15845.31,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7749.2,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11792.12,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9204.12,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15871.43,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30511.85,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16437.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"minimum":1911.7,"maximum":25069.51,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5812.94,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25069.51,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11156.83,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9938.38,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7686.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10006.74,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5813.78,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11481.89,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1911.7,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9997.17,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7477.8,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11538.38,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12121.15,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14893.80,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20979.21,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5994.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"minimum":1580.84,"maximum":22660.58,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9409.06,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12203.29,"methodology":"other"},{"payer_name":"Ar Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2679.0,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12551.54,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22660.58,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8074.49,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9738.4,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1580.84,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2944.98,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9581.35,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8296.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"minimum":20024.34,"maximum":20024.34,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20024.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"minimum":26590.94,"maximum":26590.94,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26590.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"minimum":14869.83,"maximum":14869.83,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14869.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"minimum":1423.04,"maximum":59668.84,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31472.14,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33062.5,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10263.67,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12943.42,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2818.18,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1423.04,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59668.84,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10263.67,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10466.04,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14472.87,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23712.95,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24898.2,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13777.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"minimum":2348.01,"maximum":9765.98,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5306.85,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5465.46,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7397.0,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2348.01,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9765.98,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4922.66,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4917.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"minimum":3178.06,"maximum":11740.64,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11740.64,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11552.89,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3178.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"minimum":11426.74,"maximum":12301.76,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11426.74,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12301.76,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12265.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"minimum":2050.0,"maximum":17699.36,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17699.36,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6979.41,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8073.16,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2050.0,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8050.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"minimum":6414.4,"maximum":11593.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11593.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6414.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"minimum":3099.68,"maximum":22949.72,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22949.72,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11718.22,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5636.36,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3161.68,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16614.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"minimum":2191.76,"maximum":21035.36,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6890.92,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7693.32,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8758.1,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9578.28,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21035.36,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9600.69,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3736.5,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4939.07,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5179.15,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2191.76,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12552.42,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6587.53,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3736.5,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11045.4,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3402.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"minimum":3099.68,"maximum":8454.55,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7297.96,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4925.11,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3381.4,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8454.55,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7115.2,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3565.2,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"minimum":1542.5,"maximum":60703.99,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1542.5,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13244.38,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60703.99,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21830.59,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46010.15,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11264.74,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14088.04,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23840.69,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14086.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"minimum":1675.0,"maximum":60659.54,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7108.26,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6927.08,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1897.5,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15408.78,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4436.25,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4587.65,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4587.65,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6457.18,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1675.0,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3560.44,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9392.03,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4587.65,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60659.54,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11819.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":8976.52,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8976.52,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3361.49,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8650.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"minimum":7749.2,"maximum":12189.33,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12189.33,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9996.99,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7749.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"minimum":4185.42,"maximum":6437.38,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6437.38,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"minimum":1549.84,"maximum":11147.21,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6175.98,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7210.24,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11147.21,"methodology":"other"},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10173.58,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4589.96,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.84,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6134.14,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8296.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6376.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"minimum":26747.26,"maximum":68209.36,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40212.45,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":65872.47,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68209.36,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35129.42,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35114.78,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39142.43,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47398.63,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38355.72,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26747.26,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41902.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"minimum":2160.15,"maximum":101586.15,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29071.49,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30527.7,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38832.77,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71678.81,"methodology":"other"},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79474.23,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28413.52,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78719.68,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101586.15,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56915.92,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29321.11,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30503.88,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2160.15,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46933.75,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4227.27,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3487.85,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42744.03,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90934.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"minimum":21210.11,"maximum":21210.11,"setting":"inpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21210.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"minimum":44637.32,"maximum":45400.79,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44637.32,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45400.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"minimum":6653.40,"maximum":61910.57,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21571.51,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58881.92,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61910.57,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23147.54,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23072.07,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6653.40,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6798.18,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24433.61,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25398.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"minimum":17741.29,"maximum":17741.29,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17741.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"minimum":31691.97,"maximum":36744.37,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36744.37,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31691.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"minimum":6975.7,"maximum":51792.16,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51792.16,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20491.27,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20653.34,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6975.7,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20308.16,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14862.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"minimum":9514.19,"maximum":18522.56,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9514.19,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18522.56,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11161.12,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13516.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"minimum":19468.89,"maximum":19468.89,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19468.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"minimum":4185.42,"maximum":60159.59,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60159.59,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22138.09,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4269.12,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"minimum":1998.24,"maximum":46066.62,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18104.63,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46066.62,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16734.81,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17951.42,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1998.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"minimum":2053.46,"maximum":23502.8,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22463.39,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21054.94,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2053.46,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23502.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"minimum":2167.36,"maximum":37414.49,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12952.43,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13071.29,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13045.79,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19270.49,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30612.27,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25150.33,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11612.54,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2167.36,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13074.04,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10842.1,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13232.15,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37414.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"minimum":2186.35,"maximum":141640.98,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32545.89,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30586.59,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31358.59,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2186.35,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32545.46,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":141640.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"minimum":1409.09,"maximum":92706.65,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19939.73,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26586.58,"methodology":"other"},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18572.81,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19949.20,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26121.84,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92706.65,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66689.18,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18592.84,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19825.46,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19928.03,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.09,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4742.52,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2092.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"minimum":7826.69,"maximum":21926.31,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21926.31,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16758.48,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21922.78,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15359.39,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7826.69,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8751.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"minimum":21697.76,"maximum":28576.54,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28576.54,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21697.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"minimum":7749.2,"maximum":35053.27,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35053.27,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14130.44,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7749.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"minimum":8550.15,"maximum":8550.15,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8550.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"minimum":22373.5,"maximum":23647.17,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23647.17,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22881.11,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22373.5,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23141.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"minimum":2160.0,"maximum":30237.1,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3065.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14876.13,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2160.0,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11198.78,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30237.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"minimum":11497.48,"maximum":21509.22,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12906.64,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11497.48,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21509.22,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13550.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"minimum":17952.55,"maximum":49250.64,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19918.76,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17952.55,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49250.64,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18943.39,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18061.52,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19155.56,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20288.76,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21875.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"minimum":1948.52,"maximum":33755.32,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14085.48,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14323.92,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18665.66,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33755.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12868.58,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5817.28,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14895.3,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14294.42,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1948.52,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7982.67,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17205.76,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14333.86,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27152.7,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15261.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"minimum":6652.32,"maximum":27173.53,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11219.67,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27173.53,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22754.22,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9705.73,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10850.0,"methodology":"other"},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10788.5,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6652.32,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11166.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"minimum":10226.9,"maximum":42454.25,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16909.18,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17839.65,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42454.25,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15529.49,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10226.9,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16784.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"minimum":8370.84,"maximum":20567.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20567.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14034.94,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8370.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"minimum":11011.84,"maximum":11011.84,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11011.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"minimum":12783.44,"maximum":12783.44,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12783.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"minimum":11134.27,"maximum":11134.27,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11134.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"minimum":14723.48,"maximum":22941.55,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21863.54,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22941.55,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14723.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"minimum":1061.66,"maximum":35347.28,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21605.54,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22237.5,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16391.76,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1061.66,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14993.15,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13454.47,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16424.67,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13218.56,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25008.71,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16391.67,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35347.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"minimum":2292.36,"maximum":31443.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3387.0,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30717.14,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12972.65,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31443.69,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11531.27,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12870.1,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2292.36,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5259.6,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11057.05,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12984.65,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12466.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"minimum":11773.52,"maximum":14963.13,"setting":"inpatient","payers_information":[{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11773.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12300.37,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14963.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"minimum":21824.87,"maximum":22071.31,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21824.87,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22071.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"minimum":9032.0,"maximum":21008.91,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11457.18,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9032.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10914.4,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21008.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"minimum":10607.46,"maximum":10607.46,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10607.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"minimum":12341.33,"maximum":12341.33,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12341.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"minimum":24471.32,"maximum":24471.32,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24471.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"minimum":6499.62,"maximum":6499.62,"setting":"inpatient","payers_information":[{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6499.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"minimum":9369.26,"maximum":9369.26,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9369.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"minimum":2186.2,"maximum":21270.81,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21270.81,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19932.76,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2186.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"minimum":5448.9,"maximum":27570.35,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14305.29,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12646.89,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5448.9,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12855.4,"methodology":"other"},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27570.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"minimum":5030.02,"maximum":25787.37,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25787.37,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9084.51,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5030.02,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22751.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"minimum":22218.9,"maximum":27495.46,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27495.46,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22218.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"minimum":4185.42,"maximum":33720.16,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8724.36,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20160.43,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33720.16,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12177.5,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13639.09,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5636.37,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6199.36,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4269.12,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13600.9,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28156.13,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14245.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"minimum":6199.36,"maximum":24701.96,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10179.72,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24701.96,"methodology":"other"},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23288.23,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24130.86,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9769.99,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8680.86,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6774.0,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6199.36,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13266.52,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10782.31,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8665.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"minimum":10164.26,"maximum":51983.75,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18834.96,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10164.26,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51983.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"minimum":7355.52,"maximum":36448.12,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14512.24,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14897.12,"methodology":"other"},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24838.0,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36448.12,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36028.36,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13111.06,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7355.52,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13221.55,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13210.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"minimum":11573.6,"maximum":11573.6,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11573.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":4693.72,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4693.72,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"minimum":8313.52,"maximum":8313.52,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8313.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"minimum":1549.84,"maximum":6593.46,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4592.65,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4496.35,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6034.88,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6593.46,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6199.36,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.84,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6029.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"minimum":1580.84,"maximum":10422.73,"setting":"inpatient","payers_information":[{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8879.74,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8245.5,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1580.84,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10422.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"minimum":6464.81,"maximum":12867.46,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12867.46,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6464.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"minimum":6462.71,"maximum":8600.99,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6462.71,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8600.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"minimum":4363.71,"maximum":5901.9,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4363.71,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5901.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"minimum":17033.70,"maximum":43604.19,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43604.19,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17033.70,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"minimum":8538.24,"maximum":8791.82,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8744.09,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8791.82,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8538.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"minimum":12999.16,"maximum":12999.16,"setting":"inpatient","payers_information":[{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12999.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"minimum":10443.63,"maximum":13177.77,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13177.77,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10443.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"minimum":1501.94,"maximum":14670.62,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7415.2,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8692.78,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7233.76,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14670.62,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5661.36,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5551.44,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.84,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1501.94,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2247.41,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4497.35,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11696.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"minimum":9755.16,"maximum":9755.16,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9755.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"minimum":1472.49,"maximum":13749.94,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4703.16,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11271.26,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5755.26,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13749.94,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6321.3,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6975.7,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1472.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"minimum":4265.79,"maximum":6693.26,"setting":"inpatient","payers_information":[{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4265.79,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4832.5,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6693.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"minimum":8998.92,"maximum":11230.96,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11230.96,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8998.92,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9495.04,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11161.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"minimum":3071.22,"maximum":15157.67,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7508.33,"methodology":"other"},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15157.67,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13096.98,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5895.44,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3071.22,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5238.23,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6629.85,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4696.02,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6975.7,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3071.22,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6388.86,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8296.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"minimum":13660.97,"maximum":23420.41,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13660.97,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23420.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"minimum":1857.75,"maximum":38380.5,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17689.29,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21322.24,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13867.48,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38380.5,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22638.0,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4256.07,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15327.3,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10243.70,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8584.25,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16741.68,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1857.75,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13546.15,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18522.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13474.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"minimum":1475.0,"maximum":22744.0,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1475.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22744.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14328.36,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13106.98,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12696.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"minimum":9767.09,"maximum":11333.5,"setting":"inpatient","payers_information":[{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9767.09,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10060.14,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11333.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.28,"maximum":7749.2,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5178.45,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6737.99,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6753.11,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5331.59,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3395.88,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7749.2,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6323.36,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3692.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"minimum":11122.23,"maximum":11122.23,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11122.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"minimum":3099.68,"maximum":8066.31,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6004.98,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5876.54,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8066.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"minimum":4255.86,"maximum":4255.86,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4255.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"minimum":19742.99,"maximum":19742.99,"setting":"inpatient","payers_information":[{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19742.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"minimum":9765.98,"maximum":14088.05,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13232.52,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14088.05,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9765.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"minimum":16938.31,"maximum":16938.31,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16938.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"minimum":37886.97,"maximum":37886.97,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37886.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"minimum":22684.24,"maximum":658944.32,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22684.24,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":658944.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"minimum":2063.0,"maximum":24488.05,"setting":"inpatient","payers_information":[{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24488.05,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10659.04,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2063.0,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12169.35,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6261.35,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4742.52,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14357.69,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12735.9,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8296.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"minimum":5037.69,"maximum":20983.27,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9206.98,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20983.27,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5037.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"minimum":16680.21,"maximum":16680.21,"setting":"inpatient","payers_information":[{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16680.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"minimum":15149.15,"maximum":15149.15,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15149.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"minimum":14584.57,"maximum":14584.57,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14584.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"minimum":15093.55,"maximum":29964.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29964.44,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15093.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"minimum":7447.09,"maximum":7796.44,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7796.44,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7447.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"minimum":7172.87,"maximum":9892.61,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9892.61,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7172.87,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7798.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"minimum":3099.68,"maximum":3099.68,"setting":"inpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"minimum":5436.54,"maximum":13381.46,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10736.74,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13381.46,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5436.54,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7535.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9141.20,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8782.66,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8596.45,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7005.86,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12008.74,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11724.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"minimum":1549.84,"maximum":18745.59,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8194.22,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3887.43,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8076.18,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7958.7,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12443.90,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18745.59,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6466.91,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4158.36,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2126.69,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5350.41,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6785.16,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3678.98,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3642.55,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6323.36,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3400.12,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3400.12,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.84,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1970.08,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7319.85,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10708.41,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5712.16,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5618.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"minimum":3494.69,"maximum":7297.5,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3494.69,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6811.0,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3548.08,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7297.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"minimum":11288.2,"maximum":11288.2,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11288.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"minimum":6803.74,"maximum":13572.19,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13572.19,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6803.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"minimum":14022.53,"maximum":17800.72,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17800.72,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14022.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":1959.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1959.09,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"minimum":1212.0,"maximum":42926.63,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26708.36,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42926.63,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9299.04,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1212.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"minimum":3506.14,"maximum":33331.69,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17852.43,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33331.69,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33271.08,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11754.26,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3506.14,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9728.7,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13866.76,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7049.66,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6929.98,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20322.0,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11161.12,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18499.52,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13951.4,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24020.39,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24020.39,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7342.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"minimum":1423.04,"maximum":50907.22,"setting":"inpatient","payers_information":[{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50907.22,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9346.33,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9914.49,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2974.43,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1423.04,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9970.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"minimum":1409.09,"maximum":30231.46,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4317.38,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26182.53,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5421.80,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11308.37,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23047.00,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20648.57,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13891.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9944.30,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.09,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1580.84,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30231.46,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14055.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"minimum":18155.74,"maximum":24239.94,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24239.94,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18155.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"minimum":9392.03,"maximum":32120.32,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32120.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11480.56,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12836.62,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9392.03,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10540.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.28,"maximum":2790.28,"setting":"inpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"minimum":10618.72,"maximum":10618.72,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10618.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"minimum":7152.52,"maximum":221355.96,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":221355.96,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25835.31,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7152.52,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34878.5,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17033.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"minimum":7904.2,"maximum":15636.80,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15636.80,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7904.2,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15498.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"minimum":5312.0,"maximum":32591.01,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10801.52,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13292.0,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13353.02,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23238.71,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5312.0,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9294.68,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32591.01,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8974.47,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8939.9,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6230.30,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6105.10,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21697.76,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5849.96,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5812.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"minimum":1481.1,"maximum":14631.81,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7068.58,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8090.94,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6744.48,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14631.81,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6138.41,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7870.62,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3633.02,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5220.33,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7111.72,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2650.53,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1481.1,"methodology":"other"},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5186.28,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6750.58,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2692.08,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3678.98,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2371.26,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3642.55,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5348.79,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3633.02,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4417.47,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6782.78,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10886.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"minimum":1334.43,"maximum":8519.9,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5599.97,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2185.04,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8519.9,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1334.43,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4227.27,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4742.52,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"minimum":1522.33,"maximum":22916.83,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1522.33,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9944.59,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11831.46,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22916.83,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12398.72,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22695.09,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9299.04,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1732.16,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9416.11,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4227.27,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7749.2,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2924.98,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5293.06,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5293.06,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10697.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"minimum":2634.14,"maximum":16074.0,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6117.01,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7029.43,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12857.11,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8002.32,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13363.75,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9901.0,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4015.2,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3974.88,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2634.14,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4459.29,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6038.07,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3078.26,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6100.31,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16074.0,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2818.18,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7826.72,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2634.14,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6042.99,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6440.31,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9458.07,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5783.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":3918.32,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3918.32,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"minimum":10074.35,"maximum":11851.83,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10074.35,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11851.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"minimum":6319.40,"maximum":8454.55,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8245.65,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7003.5,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6319.40,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8454.55,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8255.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"minimum":4325.99,"maximum":10073.69,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6844.99,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10073.69,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4325.99,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"minimum":37918.99,"maximum":37918.99,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37918.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"minimum":18403.37,"maximum":18403.37,"setting":"inpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18403.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"minimum":15633.03,"maximum":23289.57,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23289.57,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15633.03,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16589.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"minimum":1483.68,"maximum":39364.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13548.0,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12107.63,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12107.63,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23123.04,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18579.92,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39364.44,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7618.88,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8254.68,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1483.68,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9631.5,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1887.55,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4516.0,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4461.64,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5009.28,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6241.42,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19079.94,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9538.4,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8296.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5090.20,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":17420.63,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9337.71,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2121.3,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9431.32,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14172.01,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10083.55,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17420.63,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2990.6,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6195.1,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5636.37,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.84,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8296.0,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12689.83,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8296.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"minimum":9616.59,"maximum":9616.59,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9616.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"minimum":19312.5,"maximum":19312.5,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19312.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"minimum":1474.08,"maximum":18786.8,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10794.43,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1474.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10944.93,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15346.54,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18786.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"minimum":5630.77,"maximum":5630.77,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5630.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"minimum":12934.75,"maximum":12934.75,"setting":"inpatient","payers_information":[{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12934.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"minimum":13948.56,"maximum":72302.64,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24591.27,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25018.39,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30819.74,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":72302.64,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44131.32,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24794.4,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24794.4,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13951.4,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13948.56,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25626.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"minimum":9068.41,"maximum":39833.75,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14752.41,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16701.78,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39833.75,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37422.81,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14290.62,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14866.37,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11272.73,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9068.41,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13951.4,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11064.53,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17358.73,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30005.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"minimum":5381.14,"maximum":25918.51,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10623.53,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12023.5,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13501.11,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25918.51,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5381.14,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25897.8,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8645.01,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9848.7,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7034.12,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6358.38,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14090.91,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19531.96,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7749.2,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11391.31,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18165.68,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11517.73,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11884.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":59729.73,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4176.08,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8103.54,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1900.92,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14512.4,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59729.73,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2438.06,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5822.58,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42164.49,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5403.84,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6820.3,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6958.47,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6964.67,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2818.18,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2846.08,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5235.54,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3617.66,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3617.66,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6811.07,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10903.28,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3622.26,"methodology":"other"},{"payer_name":"Va Visn 16","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5210.1,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1472.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"minimum":2553.0,"maximum":7710.0,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4895.38,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7710.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3335.22,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4914.48,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2553.0,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"minimum":6174.96,"maximum":6174.96,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6174.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"minimum":1584.0,"maximum":9765.98,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1584.0,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8523.95,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8515.41,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8523.63,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6691.22,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4302.83,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8463.36,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9765.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"minimum":3097.1,"maximum":20322.0,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3097.1,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6255.56,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6918.56,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7258.82,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7258.82,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14151.77,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3112.22,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12043.79,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5507.09,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4434.96,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4834.43,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20322.0,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5657.91,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4505.82,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3487.85,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9170.73,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9603.4,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7666.12,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9766.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"minimum":2918.02,"maximum":3641.92,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2918.02,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3641.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"minimum":6803.56,"maximum":6803.56,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6803.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"minimum":5473.4,"maximum":6432.83,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5473.4,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6432.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"minimum":2352.72,"maximum":59081.56,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2352.72,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59081.56,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11734.19,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12327.13,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11314.4,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6975.7,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7487.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"minimum":1409.09,"maximum":12175.0,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9183.05,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7480.7,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6941.61,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2130.1,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5672.8,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1446.34,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12175.0,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.09,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5984.76,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4459.21,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8102.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"minimum":1795.0,"maximum":8370.84,"setting":"inpatient","payers_information":[{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1795.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2019.24,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8370.84,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5866.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":1395.14,"setting":"inpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"minimum":14488.79,"maximum":14488.79,"setting":"inpatient","payers_information":[{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14488.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.28,"maximum":2790.28,"setting":"inpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"minimum":8753.39,"maximum":10300.75,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8753.39,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10300.75,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8805.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"minimum":4185.42,"maximum":48548.65,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27810.79,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48548.65,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"minimum":5685.75,"maximum":5685.75,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5685.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"minimum":9917.69,"maximum":9917.69,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9917.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"minimum":4185.42,"maximum":19523.69,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12868.3,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5394.15,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19523.69,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6476.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"minimum":5580.56,"maximum":27075.37,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27075.37,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5636.36,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7710.97,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16785.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"minimum":1549.84,"maximum":20530.52,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20530.52,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16041.17,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.84,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11900.04,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8803.39,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14064.85,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9441.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":1395.14,"setting":"inpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"minimum":15887.32,"maximum":23189.92,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18741.25,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23189.92,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15887.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"minimum":11422.71,"maximum":15498.4,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11422.71,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15498.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"minimum":13333.26,"maximum":13333.26,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13333.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"minimum":6812.07,"maximum":6812.07,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6812.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.28,"maximum":5813.17,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5813.17,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"minimum":5843.8,"maximum":5843.8,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5843.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"minimum":4572.17,"maximum":4572.17,"setting":"inpatient","payers_information":[{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4572.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.28,"maximum":10957.95,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10957.95,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7710.39,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9065.22,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3164.91,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3585.0,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4269.12,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10957.95,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7325.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7325.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"minimum":1409.09,"maximum":9393.25,"setting":"inpatient","payers_information":[{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9393.25,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.09,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"minimum":1375.61,"maximum":14580.0,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6447.38,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9893.97,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4868.96,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2968.38,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2910.18,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5046.26,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1375.61,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14580.0,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1540.5,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5461.16,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7837.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"minimum":2846.08,"maximum":31982.24,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31982.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10821.33,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2846.08,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5205.27,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16757.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"minimum":2944.98,"maximum":15263.97,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9212.75,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15263.97,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12855.15,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5831.06,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10643.13,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4696.02,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3161.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2944.98,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3272.37,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8711.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11036.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"minimum":2208.04,"maximum":16272.0,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7793.17,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14360.24,"methodology":"other"},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16272.0,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8204.96,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13915.23,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5912.5,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4539.81,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5299.47,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6564.92,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2818.18,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4742.52,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2915.5,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2208.04,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2216.83,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11036.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"minimum":4185.42,"maximum":15352.24,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15352.24,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13465.15,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5636.37,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8370.84,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5692.16,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9068.41,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11036.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"minimum":2484.0,"maximum":14455.89,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9455.64,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6144.80,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14455.89,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7173.76,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13912.0,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4696.02,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5023.32,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4227.27,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4742.52,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12995.93,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2484.0,"methodology":"other"},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11036.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11036.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"minimum":2550.12,"maximum":13539.8,"setting":"inpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11036.0,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4811.2,"methodology":"other"},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6014.0,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7691.53,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8295.32,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11861.7,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6457.03,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13539.8,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5754.03,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5835.38,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11036.0,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4084.30,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4941.45,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5000.15,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8884.5,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4937.78,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13460.78,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4461.65,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3161.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2550.12,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8233.12,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3984.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11036.0,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11036.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11036.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":73740.18,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9510.11,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16964.22,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2974.43,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1423.04,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1404.78,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73740.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"minimum":11165.22,"maximum":77946.69,"setting":"inpatient","payers_information":[{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77946.69,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68763.1,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53110.66,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31046.62,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14654.05,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15500.00,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25112.52,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20550.92,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26138.01,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19011.0,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11336.55,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11165.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"minimum":9894.6,"maximum":44568.31,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44568.31,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9894.6,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21136.37,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28209.36,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21184.96,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12556.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"minimum":1400.67,"maximum":33631.96,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5611.35,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13359.34,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24949.14,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33631.96,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6731.54,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4742.52,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4417.47,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1400.67,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9077.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"minimum":3690.96,"maximum":25990.18,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3690.96,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3690.96,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25990.18,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6261.36,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5115.04,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5849.96,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9765.98,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8290.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"minimum":1302.4,"maximum":12498.79,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3094.03,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1302.4,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2817.79,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1384.11,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12498.79,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9137.66,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1400.67,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2818.18,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3161.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10689.01,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1400.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"minimum":1376.6,"maximum":4156.59,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1814.49,"methodology":"other"},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3002.82,"methodology":"other"},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4156.59,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1376.6,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2818.18,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2846.08,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3186.0,"methodology":"other"},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2345.6,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2830.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"minimum":3022.33,"maximum":8959.06,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8959.06,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8335.2,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6607.97,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3022.33,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3161.68,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7325.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.28,"maximum":10325.22,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7512.51,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10325.22,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4021.98,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8413.3,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6166.97,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7762.1,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2818.18,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4269.12,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3305.54,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7325.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6463.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"minimum":30815.04,"maximum":30815.04,"setting":"inpatient","payers_information":[{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30815.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"minimum":6261.35,"maximum":6261.35,"setting":"inpatient","payers_information":[{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6261.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"minimum":4185.42,"maximum":4185.42,"setting":"inpatient","payers_information":[{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"minimum":19029.83,"maximum":19029.83,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19029.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"minimum":3913.35,"maximum":9615.2,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9069.69,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9069.69,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9615.2,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5488.8,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6307.91,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3913.35,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8136.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"minimum":1942.37,"maximum":22362.64,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6717.27,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6604.18,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5900.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8876.24,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4937.89,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3016.65,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4518.38,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1942.37,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2818.18,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3003.88,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1942.37,"methodology":"other"},{"payer_name":"Uhc 30573","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7158.0,"methodology":"other"},{"payer_name":"Uhc 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22362.64,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7325.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7325.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7325.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"minimum":1148.14,"maximum":13736.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3061.6,"methodology":"other"},{"payer_name":"All Savers Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7325.0,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5886.04,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5886.04,"methodology":"other"},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13602.41,"methodology":"other"},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7325.0,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9014.25,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3835.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9197.75,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1148.14,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1800.94,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3173.6,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4465.6,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7325.0,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8291.0,"methodology":"other"},{"payer_name":"Joplin Claims","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2674.86,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2874.69,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3319.86,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2874.69,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1637.61,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2755.44,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3161.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9108.3,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1637.61,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1637.61,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3070.61,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8725.31,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7810.5,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2874.69,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6753.0,"methodology":"other"},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7325.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7325.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5852.56,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7325.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7325.0,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13736.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"minimum":13617.51,"maximum":15061.32,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13617.51,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15061.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"minimum":5580.56,"maximum":12410.47,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8800.47,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9630.23,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12410.47,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10848.88,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8777.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"minimum":6407.31,"maximum":6975.7,"setting":"inpatient","payers_information":[{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6407.31,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6975.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"minimum":5162.44,"maximum":12626.7,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10328.02,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12626.7,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10094.18,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5436.34,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10428.81,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10180.41,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7646.59,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5162.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"minimum":1219.38,"maximum":21214.67,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3556.82,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14652.96,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21214.67,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11413.0,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6063.93,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5234.88,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3768.87,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1219.38,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7236.92,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4227.27,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5692.16,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2092.71,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2418.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"minimum":2781.35,"maximum":26919.36,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21447.66,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9515.82,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11390.83,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2781.35,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26919.36,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11648.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18736.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"minimum":4185.42,"maximum":13214.42,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13214.42,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"minimum":3130.68,"maximum":8444.61,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6859.6,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7936.58,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8444.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"minimum":1174.63,"maximum":1174.63,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1174.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"minimum":2113.64,"maximum":3099.68,"setting":"inpatient","payers_information":[{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2113.64,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"minimum":3130.68,"maximum":3130.68,"setting":"inpatient","payers_information":[{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3130.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"minimum":13875.43,"maximum":13875.43,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13875.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.28,"maximum":8940.5,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8940.5,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7254.76,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8296.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"minimum":8010.31,"maximum":8010.31,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8010.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"minimum":7774.89,"maximum":7774.89,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7774.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"minimum":2336.99,"maximum":2336.99,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2336.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"minimum":1866.03,"maximum":16075.81,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15843.49,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16075.81,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1866.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"minimum":3336.54,"maximum":10114.76,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3336.54,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10114.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"minimum":21938.35,"maximum":74271.45,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74271.45,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21938.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"minimum":3841.76,"maximum":18098.11,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4258.8,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18098.11,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4111.12,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3841.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"minimum":1376.6,"maximum":9554.46,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6636.3,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4279.34,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8746.09,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7045.46,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1486.44,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2024.28,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9554.46,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1376.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"minimum":1488.46,"maximum":6194.83,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4604.13,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5398.17,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2626.26,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2626.26,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1565.34,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2621.64,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4789.94,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1488.46,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6194.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"minimum":20485.84,"maximum":20485.84,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20485.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"minimum":10546.36,"maximum":27902.8,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10546.36,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27902.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"minimum":12552.76,"maximum":12552.76,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12552.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"minimum":8534.43,"maximum":8534.43,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8534.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"minimum":21454.63,"maximum":21454.63,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21454.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"minimum":2458.07,"maximum":92971.19,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34257.41,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45415.52,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92971.19,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11478.92,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76249.56,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":72494.26,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34120.22,"methodology":"other"},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33016.93,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17772.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31846.74,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2458.07,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33726.17,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24115.18,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4742.52,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15346.54,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32061.64,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40276.84,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33200.11,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18092.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"minimum":6470.82,"maximum":14215.51,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13381.11,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14215.51,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6470.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"minimum":29633.38,"maximum":29633.38,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29633.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"minimum":3794.3,"maximum":25850.51,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19978.64,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11889.64,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14576.15,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14863.18,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9032.0,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3794.3,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23026.88,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25850.51,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14304.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"minimum":1919.46,"maximum":20442.21,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17595.39,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20442.21,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12941.3,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1919.46,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12810.08,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9863.64,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12787.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"minimum":3775.48,"maximum":11464.24,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3775.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7454.22,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4227.27,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11464.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"minimum":3517.08,"maximum":7286.53,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5118.51,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3517.08,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7286.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"minimum":9688.26,"maximum":11808.47,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11808.47,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9688.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":14425.45,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9562.67,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14425.45,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3442.53,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5339.19,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1656.74,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4696.02,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"minimum":14415.5,"maximum":22998.24,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22998.24,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14415.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"minimum":2818.18,"maximum":9191.49,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9191.49,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7939.53,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2818.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"minimum":34878.5,"maximum":62904.57,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62904.57,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45635.55,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34878.5,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43249.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"minimum":2292.36,"maximum":34898.87,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13758.84,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17835.35,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33858.0,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6947.15,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19582.32,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34211.75,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34898.87,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13531.25,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4518.68,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23390.84,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33375.06,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8174.87,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8623.83,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12484.7,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7117.72,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13701.01,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6390.04,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15388.96,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11241.14,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13305.38,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7749.2,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2292.36,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10690.41,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8623.83,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12178.92,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24936.33,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12234.09,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13639.9,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8296.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25503.53,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11421.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"minimum":1647.98,"maximum":17264.76,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6067.86,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15789.75,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17264.76,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6558.05,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7667.22,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3091.4,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1647.98,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8001.35,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7045.45,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6278.13,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3887.54,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7581.1,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13258.03,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13031.74,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4000.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"minimum":7826.69,"maximum":37673.52,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9826.92,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37673.52,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7826.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"minimum":1084.33,"maximum":24325.61,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3397.79,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7841.19,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3865.26,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24325.61,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6542.45,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3843.26,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1084.33,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6261.36,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5548.23,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2042.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"minimum":1730.0,"maximum":12299.55,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2179.98,"methodology":"other"},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3440.39,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4052.64,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2874.38,"methodology":"other"},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3748.0,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7249.61,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7164.2,"methodology":"other"},{"payer_name":"Ar Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3572.0,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1948.99,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4266.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5402.81,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2864.49,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6186.86,"methodology":"other"},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1730.0,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4696.02,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3076.17,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2604.23,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6223.18,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6786.71,"methodology":"other"},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4994.6,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2616.15,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12299.55,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5636.36,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5608.46,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5259.84,"methodology":"other"},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7962.25,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9611.7,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8756.85,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2514.66,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5520.25,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2451.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2859.5,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2250.70,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"minimum":1174.69,"maximum":6974.28,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1438.64,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2555.28,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5401.86,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5636.36,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6974.28,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1174.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":13170.94,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10278.94,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6246.99,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13170.94,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4696.02,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12556.26,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2451.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"minimum":2304.49,"maximum":264595.5,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8462.43,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2826.56,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":264595.5,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7098.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7255.41,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2304.49,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3372.26,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4881.46,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9228.15,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6199.36,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10528.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"minimum":1484.20,"maximum":12263.92,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1851.88,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3475.13,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2342.5,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10295.79,"methodology":"other"},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9134.8,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10276.00,"methodology":"other"},{"payer_name":"Ar Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2586.0,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7826.69,"methodology":"other"},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7553.70,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9723.64,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7317.0,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2595.0,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9325.68,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7826.69,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6670.18,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1484.20,"methodology":"other"},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10484.79,"methodology":"other"},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10211.92,"methodology":"other"},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9246.89,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3300.57,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3300.57,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3300.57,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2511.48,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2511.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8262.48,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4924.02,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4545.26,"methodology":"other"},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7353.0,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5481.16,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4612.48,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8262.04,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4163.36,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2811.0,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5636.37,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6199.36,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5889.96,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6975.7,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8154.19,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2511.48,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2511.48,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2918.19,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12263.92,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10218.74,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6536.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2042.5,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2859.5,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2703.18,"methodology":"other"},{"payer_name":"Va Visn 16","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10449.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"minimum":12991.46,"maximum":12991.46,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12991.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"minimum":9626.13,"maximum":9626.13,"setting":"inpatient","payers_information":[{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9626.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"minimum":1149.50,"maximum":7422.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1874.0,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5168.16,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4928.46,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1951.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3193.5,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4665.52,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6161.26,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4461.64,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1839.19,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1877.3,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7422.02,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1149.50,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"minimum":4185.42,"maximum":12389.69,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12389.69,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11504.67,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8454.55,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5692.16,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4185.42,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6387.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"minimum":1473.50,"maximum":8291.16,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1973.2,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6832.81,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7696.92,"methodology":"other"},{"payer_name":"Ar Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3572.0,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8291.16,"methodology":"other"},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2010.0,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7801.22,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6021.02,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4920.83,"methodology":"other"},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6846.68,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4294.29,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4294.29,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4294.29,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2329.16,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4920.83,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6701.59,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1583.95,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5674.96,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6261.35,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.56,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2329.16,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1473.50,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6561.62,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3586.76,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3676.5,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1887.5,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1711.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"minimum":13093.91,"maximum":13658.51,"setting":"inpatient","payers_information":[{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13294.69,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13658.51,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13093.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"minimum":6975.7,"maximum":45832.43,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24905.70,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24823.51,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24881.36,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20989.64,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15022.44,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6975.7,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45832.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"minimum":13207.97,"maximum":26922.22,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13207.97,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13626.95,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20050.06,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26922.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"minimum":2470.39,"maximum":6278.13,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2470.39,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5636.37,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6278.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"minimum":1549.84,"maximum":11005.46,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11005.46,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"minimum":3662.26,"maximum":9863.64,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5216.33,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5926.53,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3662.26,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9863.64,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"minimum":4227.27,"maximum":22595.49,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14356.62,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14356.62,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6019.36,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22595.49,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9021.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10967.69,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4227.27,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11743.86,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7673.27,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11334.42,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12319.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"minimum":3161.68,"maximum":20036.42,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6947.09,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9955.39,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11884.58,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20036.42,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5391.82,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3913.35,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3161.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7673.27,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9299.04,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8441.16,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3268.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"minimum":1415.27,"maximum":12999.61,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12999.61,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1415.27,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4227.27,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.84,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"minimum":3977.06,"maximum":16139.82,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3977.06,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16139.82,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7732.21,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7113.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"minimum":5876.18,"maximum":8296.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8296.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5876.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"minimum":8370.84,"maximum":11533.26,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11533.26,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8370.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.28,"maximum":2790.28,"setting":"inpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"minimum":21883.17,"maximum":21883.17,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21883.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"minimum":13464.73,"maximum":13464.73,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13464.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"minimum":11445.45,"maximum":11445.45,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11445.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"minimum":3099.68,"maximum":15149.37,"setting":"inpatient","payers_information":[{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3327.23,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8805.41,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9879.78,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3099.68,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15149.37,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15149.37,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10289.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"minimum":2500.86,"maximum":37133.53,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23296.21,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37133.53,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10725.47,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18286.67,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2500.86,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11165.96,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13956.94,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14230.4,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5441.7,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9695.3,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7018.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"minimum":2843.0,"maximum":59703.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59703.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2843.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16277.20,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7784.27,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55794.24,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14406.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17986.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"minimum":14413.4,"maximum":22744.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22744.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14413.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"minimum":2818.18,"maximum":19679.03,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19679.03,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4977.95,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2818.18,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3161.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"minimum":85473.67,"maximum":85473.67,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85473.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"minimum":10535.44,"maximum":25873.89,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25873.89,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24675.48,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10535.44,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25869.56,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25867.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.28,"maximum":119540.72,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47310.87,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":119540.72,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46350.02,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"minimum":9080.90,"maximum":61845.65,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9080.90,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36386.78,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61845.65,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25647.83,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26946.15,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24205.31,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9765.98,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21846.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"minimum":35722.93,"maximum":35722.93,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35722.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"minimum":17463.5,"maximum":44886.71,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44886.71,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17463.5,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22322.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":18168.1,"setting":"inpatient","payers_information":[{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7110.88,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13141.41,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4696.02,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18168.1,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11136.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"minimum":1395.14,"maximum":8296.0,"setting":"inpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.14,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8296.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"minimum":7826.69,"maximum":20840.99,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20840.99,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7826.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"minimum":1398.85,"maximum":1398.85,"setting":"inpatient","payers_information":[{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1398.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"minimum":11275.73,"maximum":50475.5,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31380.28,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23379.33,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24823.02,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50475.5,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30197.47,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32240.06,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32041.23,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13951.4,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11275.73,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44027.28,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17863.1,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33455.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"minimum":1227.9,"maximum":41083.73,"setting":"inpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16939.42,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16948.82,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41083.73,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15322.27,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15532.78,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1227.9,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16932.68,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16960.67,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1565.34,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27920.53,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24592.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"minimum":10820.47,"maximum":11417.16,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11417.16,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10820.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"minimum":4516.0,"maximum":31932.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4516.0,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31932.33,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23589.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"minimum":8893.86,"maximum":23906.4,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23906.4,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10383.08,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10848.88,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8893.86,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13130.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"minimum":7909.16,"maximum":18641.66,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18641.66,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7909.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"minimum":2846.08,"maximum":4649.52,"setting":"inpatient","payers_information":[{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2846.08,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4649.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"minimum":12097.15,"maximum":35706.11,"setting":"inpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35706.11,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12097.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj. olanzapine, 0.5mg","code_information":[{"code":"0724","type":"APC"}],"standard_charges":[{"minimum":5.25,"maximum":5.25,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amphotericin b liposome inj","code_information":[{"code":"0736","type":"APC"}],"standard_charges":[{"minimum":5.25,"maximum":5.25,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Rasburicase","code_information":[{"code":"0738","type":"APC"}],"standard_charges":[{"minimum":12393.27,"maximum":12393.27,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12393.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gammagard liquid injection","code_information":[{"code":"0944","type":"APC"}],"standard_charges":[{"minimum":3739.54,"maximum":3739.54,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3739.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gamunex-C/Gammaked","code_information":[{"code":"0948","type":"APC"}],"standard_charges":[{"minimum":5.25,"maximum":26933.54,"setting":"outpatient","payers_information":[{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":670.75,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26933.54,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.25,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2086.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Albumin (human), 5%, 250 ml","code_information":[{"code":"0963","type":"APC"}],"standard_charges":[{"minimum":3.12,"maximum":3.12,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Albumin (human), 25%, 50ml","code_information":[{"code":"0965","type":"APC"}],"standard_charges":[{"minimum":5.25,"maximum":418.62,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":418.62,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"I131 iodide sol, rx","code_information":[{"code":"1150","type":"APC"}],"standard_charges":[{"minimum":229.36,"maximum":900.63,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":900.63,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":229.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj IVIG privigen 500 mg","code_information":[{"code":"1214","type":"APC"}],"standard_charges":[{"minimum":329.72,"maximum":7882.93,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7882.93,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":329.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, vasopressin, 1 unit","code_information":[{"code":"1233","type":"APC"}],"standard_charges":[{"minimum":16.34,"maximum":16.34,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Degarelix injection","code_information":[{"code":"1296","type":"APC"}],"standard_charges":[{"minimum":401.96,"maximum":401.96,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":401.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Visualization adjunct","code_information":[{"code":"1446","type":"APC"}],"standard_charges":[{"minimum":583.35,"maximum":34126.46,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":583.35,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34126.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj filgrastim excl biosimil","code_information":[{"code":"1469","type":"APC"}],"standard_charges":[{"minimum":243.28,"maximum":243.28,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":243.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, Pertuzumab, 1 mg","code_information":[{"code":"1471","type":"APC"}],"standard_charges":[{"minimum":9549.53,"maximum":9549.53,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9549.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Darbepoetin alfa, esrd use","code_information":[{"code":"1482","type":"APC"}],"standard_charges":[{"minimum":8.53,"maximum":6940.78,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3317.21,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2257.5,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4241.42,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4517.04,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":480.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3263.38,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3164.41,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1193.39,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8.53,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2695.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6940.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj vedolizumab iv 1 mg","code_information":[{"code":"1489","type":"APC"}],"standard_charges":[{"minimum":3.93,"maximum":9255.1,"setting":"outpatient","payers_information":[{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9255.1,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj pembrolizumab","code_information":[{"code":"1490","type":"APC"}],"standard_charges":[{"minimum":8731.51,"maximum":12203.24,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12203.24,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8731.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Darbepoetin alfa, non-esrd","code_information":[{"code":"1685","type":"APC"}],"standard_charges":[{"minimum":5.25,"maximum":1752.0,"setting":"outpatient","payers_information":[{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58.93,"methodology":"other"},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":240.08,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1752.0,"methodology":"other"},{"payer_name":"Joplin Claims","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":995.04,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":635.86,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fomepizole","code_information":[{"code":"1689","type":"APC"}],"standard_charges":[{"minimum":5.25,"maximum":5.25,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Radium ra223 dichloride ther","code_information":[{"code":"1745","type":"APC"}],"standard_charges":[{"minimum":23062.36,"maximum":23062.36,"setting":"outpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23062.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, dalbavancin","code_information":[{"code":"1823","type":"APC"}],"standard_charges":[{"minimum":3754.22,"maximum":7315.14,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7315.14,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3754.22,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5225.36,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5963.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Penicillin g benzathine inj","code_information":[{"code":"1829","type":"APC"}],"standard_charges":[{"minimum":335.28,"maximum":668.36,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":606.56,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":335.28,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":621.73,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":668.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, inflectra","code_information":[{"code":"1847","type":"APC"}],"standard_charges":[{"minimum":1244.91,"maximum":1626.7,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1626.7,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1244.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gamma globulin > 10 cc inj","code_information":[{"code":"1851","type":"APC"}],"standard_charges":[{"minimum":5.25,"maximum":5.25,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"minimum":42.43,"maximum":879.16,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":355.0,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.05,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.89,"methodology":"other"},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":141.31,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78.91,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":879.16,"methodology":"other"},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":116.48,"methodology":"other"},{"payer_name":"All Savers Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44.46,"methodology":"other"},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":187.56,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":163.79,"methodology":"other"},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":163.79,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":163.79,"methodology":"other"},{"payer_name":"American Natl Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.15,"methodology":"other"},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":187.56,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":333.0,"methodology":"other"},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":317.11,"methodology":"other"},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.15,"methodology":"other"},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":343.94,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":283.88,"methodology":"other"},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":283.0,"methodology":"other"},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":282.02,"methodology":"other"},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":218.82,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44.46,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":210.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.0,"methodology":"other"},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.0,"methodology":"other"},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42.43,"methodology":"other"},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.15,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.15,"methodology":"other"},{"payer_name":"Cox Health Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":119.78,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":167.26,"methodology":"other"},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":139.52,"methodology":"other"},{"payer_name":"Everest","plan_name":"Everest","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.15,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":317.0,"methodology":"other"},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":333.0,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":202.68,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":153.71,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59.74,"methodology":"other"},{"payer_name":"Manhattan Life","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":281.68,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.15,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.18,"methodology":"other"},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.9,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":149.36,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.15,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.42,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.52,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":186.8,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.92,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44.72,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":94.34,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.70,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44.28,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44.28,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44.28,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44.28,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":107.8,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":112.96,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44.82,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.66,"methodology":"other"},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44.72,"methodology":"other"},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":108.62,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":154.03,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":124.16,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114.06,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.04,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.15,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.5,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":150.88,"methodology":"other"},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":233.78,"methodology":"other"},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.51,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":108.62,"methodology":"other"},{"payer_name":"Tribal Member","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":214.18,"methodology":"other"},{"payer_name":"Tricare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":109.57,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":217.4,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":224.58,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":109.57,"methodology":"other"},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":244.41,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.72,"methodology":"other"},{"payer_name":"Uhc 30573","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":375.0,"methodology":"other"},{"payer_name":"Uhc 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Uhc 740818","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":373.5,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":359.58,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44.82,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":141.31,"methodology":"other"},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":373.5,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44.46,"methodology":"other"},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110.73,"methodology":"other"},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":355.0,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":376.0,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":355.0,"methodology":"other"},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":368.65,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":402.0,"methodology":"other"},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":375.0,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":361.15,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":112.96,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":112.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"minimum":45.45,"maximum":1765.0,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":278.0,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.87,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":207.32,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110.01,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110.01,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":292.0,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1765.0,"methodology":"other"},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":278.0,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.87,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":292.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":292.0,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":292.0,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":421.0,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":421.0,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114.76,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":285.0,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.94,"methodology":"other"},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.87,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.87,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.45,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.45,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.04,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":181.34,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.66,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.87,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.87,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.87,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":139.99,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.87,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.87,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.86,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.12,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":197.38,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.94,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67.5,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.57,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":72.26,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60.85,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70.68,"methodology":"other"},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":292.0,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.15,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73.59,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66.98,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.56,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.36,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":278.0,"methodology":"other"},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":292.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":292.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":295.25,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":292.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.87,"methodology":"other"},{"payer_name":"Va Visn 16","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.87,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":681.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"minimum":45.45,"maximum":921.5,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":139.67,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":548.83,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":202.65,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":180.67,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":709.0,"methodology":"other"},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":709.0,"methodology":"other"},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":409.0,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":709.0,"methodology":"other"},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":715.5,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138.76,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":709.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":709.0,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":490.08,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":278.64,"methodology":"other"},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":709.0,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.45,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138.96,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.45,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53.97,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.45,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":130.19,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.52,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":139.16,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":123.91,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":252.85,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138.96,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":195.01,"methodology":"other"},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138.96,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":131.89,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":139.76,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":139.76,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138.96,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":141.91,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":849.69,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":173.07,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138.46,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":141.12,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":120.74,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":121.70,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":130.19,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138.46,"methodology":"other"},{"payer_name":"Tricare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":675.0,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135.57,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":921.5,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":174.84,"methodology":"other"},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":840.03,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.96,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":709.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":692.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":709.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":139.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"minimum":40.63,"maximum":2661.78,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":215.05,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":215.98,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":241.64,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1033.98,"methodology":"other"},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1643.6,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":353.52,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":353.52,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1765.0,"methodology":"other"},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":239.91,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1217.0,"methodology":"other"},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1817.77,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":241.33,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1097.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1292.02,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2065.75,"methodology":"other"},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1581.67,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2447.53,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2661.78,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":681.87,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":752.82,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1191.0,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":634.0,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":512.97,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":502.02,"methodology":"other"},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.79,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":134.04,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":240.93,"methodology":"other"},{"payer_name":"Medben","plan_name":"Medben","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":227.13,"methodology":"other"},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135.08,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.32,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":107.85,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":94.19,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40.63,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":227.13,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":255.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":239.91,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":240.93,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":240.73,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":244.02,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":216.68,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138.96,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":239.42,"methodology":"other"},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":214.59,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":241.64,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":243.81,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":290.78,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":216.18,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":245.57,"methodology":"other"},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":351.06,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1796.3,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1233.29,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":398.08,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":353.75,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.67,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":286.87,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1488.0,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":233.54,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":229.76,"methodology":"other"},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":865.48,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":298.34,"methodology":"other"},{"payer_name":"Tribal Member","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1503.46,"methodology":"other"},{"payer_name":"Tricare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":353.0,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":236.5,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":426.67,"methodology":"other"},{"payer_name":"Uhc 30573","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Uhc 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":240.93,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":305.01,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":240.94,"methodology":"other"},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":305.01,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1031.0,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":239.91,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":243.81,"methodology":"other"},{"payer_name":"Va Visn 16","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":173.42,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":399.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"minimum":189.23,"maximum":4724.6,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":610.99,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":641.46,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":557.77,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna 14079","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2824.09,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2766.16,"methodology":"other"},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3097.72,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":797.6,"methodology":"other"},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":768.70,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":812.4,"methodology":"other"},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1760.2,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1770.69,"methodology":"other"},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":534.74,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1768.48,"methodology":"other"},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1559.54,"methodology":"other"},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1769.67,"methodology":"other"},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1668.36,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":589.18,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1102.18,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1767.40,"methodology":"other"},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1772.35,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2787.40,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3454.96,"methodology":"other"},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3848.0,"methodology":"other"},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1056.1,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3078.0,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1399.66,"methodology":"other"},{"payer_name":"Cox Health Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1652.37,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1846.28,"methodology":"other"},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1757.77,"methodology":"other"},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3018.0,"methodology":"other"},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":590.25,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1145.7,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":920.26,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":515.65,"methodology":"other"},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":397.24,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":229.22,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":482.52,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":575.67,"methodology":"other"},{"payer_name":"Medben","plan_name":"Medben","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":673.3,"methodology":"other"},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":898.93,"methodology":"other"},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1682.0,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":189.23,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":226.56,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":239.24,"methodology":"other"},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":433.1,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":591.68,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":513.16,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":560.74,"methodology":"other"},{"payer_name":"Medicaid Other States","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4724.6,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":571.07,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":571.15,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":578.1,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":576.07,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":558.59,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":592.18,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":541.42,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":658.46,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":541.27,"methodology":"other"},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":335.36,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":569.77,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":517.02,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":580.36,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":595.68,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":649.9,"methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3497.45,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2464.66,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3075.9,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":852.84,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":625.88,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":643.98,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":625.0,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":575.78,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":477.64,"methodology":"other"},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":448.82,"methodology":"other"},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2519.38,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":622.09,"methodology":"other"},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3340.89,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":671.58,"methodology":"other"},{"payer_name":"Tribal Member","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1805.38,"methodology":"other"},{"payer_name":"Tricare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":529.86,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":502.44,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":589.44,"methodology":"other"},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1176.50,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1155.09,"methodology":"other"},{"payer_name":"Uhc","plan_name":"Uhc 30975","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Uhc 30573","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1031.0,"methodology":"other"},{"payer_name":"Uhc 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Uhc 740818","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1201.0,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":464.99,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":688.14,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":571.17,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":873.56,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":582.17,"methodology":"other"},{"payer_name":"Va Visn 16","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":330.7,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":534.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"minimum":110.0,"maximum":66814.27,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2301.58,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1165.22,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":956.07,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna 14079","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":254.89,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3965.86,"methodology":"other"},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66814.27,"methodology":"other"},{"payer_name":"All Savers Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10657.83,"methodology":"other"},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2503.26,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1307.29,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1558.78,"methodology":"other"},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":616.5,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1768.47,"methodology":"other"},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110.0,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1770.29,"methodology":"other"},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4062.0,"methodology":"other"},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1769.12,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":991.48,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1109.15,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1771.04,"methodology":"other"},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":514.4,"methodology":"other"},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":319.0,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3078.0,"methodology":"other"},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3848.0,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3275.0,"methodology":"other"},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2301.58,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3848.0,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2294.54,"methodology":"other"},{"payer_name":"Cox Health Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2571.52,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3257.93,"methodology":"other"},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1068.34,"methodology":"other"},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2301.58,"methodology":"other"},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2301.58,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1903.84,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":983.54,"methodology":"other"},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1006.18,"methodology":"other"},{"payer_name":"Joplin Claims","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":444.51,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":274.75,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2153.77,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":918.99,"methodology":"other"},{"payer_name":"Medben","plan_name":"Medben","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2294.62,"methodology":"other"},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1028.05,"methodology":"other"},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":288.62,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":326.33,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":378.96,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":389.67,"methodology":"other"},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2937.90,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":754.34,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":935.94,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":774.64,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1115.22,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4635.37,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":837.38,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":781.98,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":859.74,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2805.62,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":512.5,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":913.01,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1889.96,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":901.59,"methodology":"other"},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2399.54,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":795.5,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1079.55,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":819.04,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":961.28,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":984.54,"methodology":"other"},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":992.52,"methodology":"other"},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.73,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9094.86,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3787.85,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1281.85,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":931.1,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":989.56,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":968.57,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1645.64,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1778.00,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":658.98,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":891.1,"methodology":"other"},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2301.58,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":790.9,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":758.25,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":905.42,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":785.39,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2324.86,"methodology":"other"},{"payer_name":"Uhc 30573","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1031.0,"methodology":"other"},{"payer_name":"Uhc 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":935.28,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1131.93,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":936.71,"methodology":"other"},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2212.2,"methodology":"other"},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1081.96,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1011.57,"methodology":"other"},{"payer_name":"Va Visn 16","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":687.4,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":766.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"minimum":21.28,"maximum":8651.12,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2294.92,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7322.0,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3391.55,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6001.38,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2294.62,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.30,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5995.21,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8651.12,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5241.76,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7986.25,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21.28,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5863.88,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2294.22,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":610.23,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1135.43,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2301.58,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.0,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2294.62,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1486.82,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1005.96,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":120.0,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2584.24,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1206.64,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1839.35,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1743.18,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1094.54,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1101.42,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1980.55,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":735.53,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2431.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1313.2,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2301.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"minimum":168.34,"maximum":9964.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9964.01,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":411.86,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":337.05,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":212.54,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.0,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":471.4,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":208.18,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":212.8,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":171.08,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":211.94,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":168.34,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":216.26,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":349.54,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":270.96,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":311.58,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":287.19,"methodology":"other"},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6176.48,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":277.77,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":346.02,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":397.09,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":284.04,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":282.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"minimum":7.39,"maximum":3101.0,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":433.52,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":378.21,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":657.86,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":341.8,"methodology":"other"},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":433.52,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3101.0,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":338.77,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":172.5,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":377.85,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":746.51,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":574.86,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":446.44,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":339.77,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":339.43,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":378.21,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":232.46,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":340.74,"methodology":"other"},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7.39,"methodology":"other"},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":446.44,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":589.61,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":510.25,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":470.83,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":501.99,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":624.23,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":526.37,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":617.47,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":731.28,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":313.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":453.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"minimum":536.68,"maximum":2021.0,"setting":"outpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1131.71,"methodology":"other"},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1137.8,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1153.94,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1247.36,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":639.24,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":536.68,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":647.77,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2021.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"minimum":1451.68,"maximum":5521.36,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1768.8,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3441.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3839.99,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5521.36,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3826.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1570.03,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1876.24,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1916.44,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1533.15,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1846.16,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2842.91,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1871.88,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2983.36,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1451.68,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1564.59,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3222.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"minimum":2403.5,"maximum":6695.18,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2403.5,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6383.6,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2403.5,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3010.89,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6695.18,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3327.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"minimum":894.45,"maximum":894.45,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":894.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"minimum":102.82,"maximum":6879.5,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":569.58,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":572.17,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":595.1,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1299.50,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":952.16,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1201.94,"methodology":"other"},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3816.0,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":594.9,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1210.78,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1835.64,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6879.5,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":934.80,"methodology":"other"},{"payer_name":"Goldins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1206.65,"methodology":"other"},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1131.69,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":591.6,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":353.08,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":102.82,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":591.6,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":828.67,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":596.7,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":595.2,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":589.2,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":595.2,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":590.4,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":837.92,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":595.61,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":631.08,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":633.59,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":591.6,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":569.58,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":583.18,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":961.95,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":592.5,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2781.02,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":601.22,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":601.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"minimum":148.41,"maximum":9855.18,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1316.11,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1316.66,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1363.62,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna 14079","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9855.18,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2049.49,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2008.86,"methodology":"other"},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1363.25,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3833.99,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3685.19,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1363.41,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2307.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3052.82,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2796.0,"methodology":"other"},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2463.01,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5001.0,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1408.36,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3000.81,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":148.41,"methodology":"other"},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1316.11,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3015.93,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2639.53,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1353.47,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1433.47,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":588.27,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":524.76,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":608.4,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":197.73,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1298.42,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":332.64,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1366.48,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1363.23,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1398.18,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1423.88,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1363.71,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1397.84,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1359.72,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1385.42,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1389.87,"methodology":"other"},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1411.36,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6773.82,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1841.80,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1509.89,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1445.62,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1565.74,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1337.51,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1120.15,"methodology":"other"},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1453.31,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1418.34,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1367.09,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1363.21,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1343.86,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2216.68,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2392.0,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2260.3,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.16,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1357.72,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1551.70,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1385.42,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1385.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"minimum":6.91,"maximum":14630.88,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2267.23,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2324.68,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12850.88,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3044.14,"methodology":"other"},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2267.23,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5096.42,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2382.4,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2172.97,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3823.39,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2267.23,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5409.44,"methodology":"other"},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2267.23,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2267.23,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2381.55,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3597.39,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":367.99,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":464.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2389.26,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2387.16,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2265.52,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2409.34,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2413.15,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2385.55,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2379.55,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2385.5,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2381.55,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2428.11,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2428.11,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14630.88,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3922.54,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4350.57,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2416.60,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2989.10,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6.91,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2267.23,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2355.27,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2389.27,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2428.11,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2584.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2428.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"minimum":312.0,"maximum":24581.85,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5483.25,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4385.84,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23898.11,"methodology":"other"},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3199.57,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4722.95,"methodology":"other"},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5483.25,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3839.91,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3197.77,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3709.71,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3863.44,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5577.6,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5183.53,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6070.18,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3230.54,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":312.0,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1605.14,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3205.09,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3197.57,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3199.57,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5466.96,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3197.57,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8205.84,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8796.85,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3587.48,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6949.08,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3258.22,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3159.49,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6857.62,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5460.97,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4522.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2586.3,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24581.85,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3257.21,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5483.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"minimum":890.21,"maximum":65405.93,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6320.93,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5466.87,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8079.99,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12525.97,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5483.25,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2366.50,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12514.39,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22984.0,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5864.58,"methodology":"other"},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5200.41,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8155.55,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5472.10,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5483.25,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5483.25,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7900.15,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5605.81,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5489.76,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5670.03,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5572.41,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5452.69,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5575.18,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":65405.93,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6900.45,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8372.27,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8533.27,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10368.4,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6920.86,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5216.12,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13300.08,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5465.57,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4367.18,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":890.21,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5377.5,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7184.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5093","type":"APC"}],"standard_charges":[{"minimum":95.85,"maximum":26573.47,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7900.06,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8787.76,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7897.3,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7331.91,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22025.19,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26573.47,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9411.26,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7926.38,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7901.65,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4833.16,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.85,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14823.03,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8101.56,"methodology":"other"},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15322.52,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5691.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5094","type":"APC"}],"standard_charges":[{"minimum":14387.99,"maximum":14387.99,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14387.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"minimum":166.5,"maximum":773.99,"setting":"outpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":351.92,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":359.03,"methodology":"other"},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":309.89,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":176.24,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":166.5,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":652.96,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":773.99,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":277.07,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":211.37,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":252.34,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":176.24,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":176.24,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":397.19,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":317.75,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":323.87,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":309.82,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":399.13,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":287.73,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":383.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"minimum":291.01,"maximum":359.2,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":359.2,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":291.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"minimum":202.26,"maximum":3801.29,"setting":"outpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3801.29,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3577.8,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1196.54,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":438.94,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":202.26,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":362.18,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":205.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"minimum":1.4,"maximum":17177.45,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1259.04,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1991.42,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1991.42,"methodology":"other"},{"payer_name":"Ar Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.0,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1351.42,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3018.58,"methodology":"other"},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3848.0,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2756.39,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1347.92,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1.4,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":630.20,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":642.55,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1351.42,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1347.92,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1351.42,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1352.42,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1349.92,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1347.22,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1372.84,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17177.45,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2689.29,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1789.00,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1789.71,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2900.14,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1328.82,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1351.62,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1345.93,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2284.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2284.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1889.5,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1373.39,"methodology":"other"},{"payer_name":"Va Visn 16","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":961.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"minimum":88.2,"maximum":13642.68,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2612.52,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2662.46,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":88.2,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7494.01,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4010.61,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4010.61,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2719.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6385.83,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6309.95,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5551.25,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2721.68,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":531.31,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":475.52,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2579.37,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2721.68,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2719.38,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2609.4,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2716.62,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2716.62,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2710.63,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3662.98,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2612.52,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5172.18,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3517.13,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2872.60,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2797.34,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4320.64,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1912.52,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2817.03,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2682.96,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4425.51,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3390.8,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1470.32,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2234.62,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3171.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13642.68,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2726.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2771.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"minimum":1360.56,"maximum":27484.83,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6015.48,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5997.93,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8864.27,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12585.82,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6841.28,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5996.72,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4018.03,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6408.15,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21743.45,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6444.58,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2250.31,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12269.39,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6015.48,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5943.99,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5689.79,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6015.48,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5788.35,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5998.52,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6075.63,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5997.02,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5991.02,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5997.02,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5991.23,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6221.14,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7089.38,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6133.11,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6372.68,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8870.46,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6015.48,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6123.44,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5723.91,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1360.56,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6641.82,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27484.83,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9781.26,"methodology":"other"},{"payer_name":"Uhc 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6015.48,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7536.76,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5994.03,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3171.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4106.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4108.58,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6113.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"minimum":4.82,"maximum":54980.75,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11146.12,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11117.93,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11119.43,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6533.41,"methodology":"other"},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11146.12,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16442.87,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16579.62,"methodology":"other"},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11218.8,"methodology":"other"},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13094.74,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1906.43,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21391.04,"methodology":"other"},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4.82,"methodology":"other"},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21643.6,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11137.70,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13141.68,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21332.34,"methodology":"other"},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11238.92,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29019.0,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8031.70,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6140.72,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22856.53,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11238.92,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11251.27,"methodology":"other"},{"payer_name":"Medben","plan_name":"Medben","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":393.45,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3994.24,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4763.66,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3930.02,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6005.78,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11218.8,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11118.11,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11120.61,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11712.57,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5702.67,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11210.38,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11119.11,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11120.24,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11202.55,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11732.65,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11376.84,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11408.64,"methodology":"other"},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11238.92,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54980.75,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14925.44,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12016.69,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11954.26,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12677.12,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12358.36,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10982.2,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10533.90,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11373.25,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":325.0,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11646.94,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18270.68,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12532.83,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14439.26,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11114.77,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18399.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18399.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11373.37,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11657.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"minimum":9611.01,"maximum":29287.39,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15767.33,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15794.12,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29287.39,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15749.89,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21098.36,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17295.35,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15834.73,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15730.99,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15744.15,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15705.48,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15612.4,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9611.01,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16016.82,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15868.27,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16079.55,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12805.39,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16016.82,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15729.49,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19957.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19960.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16018.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Airway Endoscopy","code_information":[{"code":"5151","type":"APC"}],"standard_charges":[{"minimum":270.56,"maximum":594.83,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":323.92,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":594.83,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":441.76,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":270.56,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":277.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Airway Endoscopy","code_information":[{"code":"5152","type":"APC"}],"standard_charges":[{"minimum":480.86,"maximum":480.86,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":480.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"minimum":313.0,"maximum":3822.89,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2628.51,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2727.22,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2109.74,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2103.01,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3822.89,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1427.14,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3818.43,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1427.14,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3148.84,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1427.14,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2108.26,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3142.04,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1421.34,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1427.34,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1450.35,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1450.35,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1916.24,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1464.43,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":768.02,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1424.16,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1351.1,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1427.14,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1406.84,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1421.35,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":313.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1450.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"minimum":1046.08,"maximum":11780.85,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4419.17,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1149.06,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6626.34,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11780.85,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4640.06,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1992.22,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3145.29,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1995.78,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4370.34,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6422.49,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1160.32,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4476.60,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3457.46,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1828.32,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1046.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5755.01,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7025.49,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7001.05,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7154.86,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3145.44,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4386.40,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5199.62,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5878.92,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4867.77,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2755.98,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4776.34,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3827.48,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5240.76,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6570.71,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7013.58,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4879.5,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6265.5,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2713.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2865.78,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3347.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"minimum":2740.5,"maximum":15273.78,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6284.26,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5484.51,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5755.01,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3423.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6544.39,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6473.57,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5737.62,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15273.78,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6098.48,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7116.24,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2740.5,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5851.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"minimum":282.46,"maximum":375.0,"setting":"outpatient","payers_information":[{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":351.88,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":282.46,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":375.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 ENT Procedures","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"minimum":466.26,"maximum":695.09,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":573.79,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":466.26,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":695.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"minimum":541.08,"maximum":6358.0,"setting":"outpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1889.61,"methodology":"other"},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1282.33,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6358.0,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":541.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1282.33,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1284.62,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1328.86,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1559.71,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1247.77,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1973.76,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1206.55,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1214.0,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1214.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"minimum":1068.33,"maximum":12426.26,"setting":"outpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3989.28,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3989.28,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6711.5,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4058.33,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6388.55,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12426.26,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6202.86,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5121.05,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3604.25,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1068.33,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2707.21,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2707.21,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2696.21,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2702.81,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3521.57,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2725.53,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2871.43,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2715.67,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1183.26,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2602.21,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6993.88,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2751.22,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2351.5,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2759.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"minimum":98.77,"maximum":10043.48,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4910.04,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7256.12,"methodology":"other"},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4947.91,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4909.84,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6394.64,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10043.48,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4924.15,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2736.63,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1326.54,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1668.98,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":98.77,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4924.15,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4909.64,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4910.64,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4960.84,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4910.14,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4910.14,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4904.14,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5004.22,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6379.93,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5007.9,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5153.49,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4834.94,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4686.47,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4689.23,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4734.81,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8006.75,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4924.16,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6459.24,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1527.16,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3585.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3586.29,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5014.58,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5004.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cochlear Implant Procedure","code_information":[{"code":"5166","type":"APC"}],"standard_charges":[{"minimum":28115.45,"maximum":57512.52,"setting":"outpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41551.1,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28655.93,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37504.39,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57512.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28115.45,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28197.44,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44792.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"minimum":370.75,"maximum":3816.0,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":583.98,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3816.0,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":530.98,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3816.0,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":604.64,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":604.64,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":607.68,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":370.75,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":604.11,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":608.18,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":526.08,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":610.12,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":647.82,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":699.63,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":528.23,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":526.09,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":606.79,"methodology":"other"},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":536.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"minimum":734.28,"maximum":3853.93,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1360.23,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1346.38,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2674.99,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3853.93,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1343.92,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1346.65,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1341.18,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1341.18,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1345.18,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1343.18,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":734.28,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3311.34,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1481.12,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3416.34,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2520.83,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1305.84,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1327.65,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2522.76,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1359.79,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1341.18,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1370.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"minimum":395.02,"maximum":6353.91,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2693.31,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2675.2,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2675.2,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3949.47,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3985.99,"methodology":"other"},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2680.19,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3898.28,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2682.41,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3835.04,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1327.27,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6353.91,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5518.07,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2680.19,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1369.3,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2680.19,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2674.79,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2676.79,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2701.99,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2695.99,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2675.29,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2675.19,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2670.48,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2723.77,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2723.77,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2669.3,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1623.28,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":395.02,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5506.53,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3419.97,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5535.49,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4543.27,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2674.74,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2421.30,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2541.62,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4064.31,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3171.0,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3625.37,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2669.3,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2586.25,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3928.62,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":469.5,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2723.77,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2365.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"minimum":2284.39,"maximum":9686.58,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4601.98,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6809.04,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2284.39,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4620.76,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4620.76,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4620.76,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4606.87,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4601.97,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4695.89,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9686.58,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8954.02,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4620.76,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4585.34,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4699.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"minimum":948.41,"maximum":24300.75,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2757.43,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3662.84,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2747.85,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17275.07,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4056.96,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4056.96,"methodology":"other"},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2685.98,"methodology":"other"},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2757.43,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13783.08,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13765.62,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2747.64,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7348.91,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13779.14,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11497.94,"methodology":"other"},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2757.43,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1258.6,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2753.35,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1939.75,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2348.7,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":976.83,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2645.55,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2757.43,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2747.44,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2749.44,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2774.61,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2780.61,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2930.94,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2747.94,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2741.94,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2747.94,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2746.21,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2797.9,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2797.9,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16780.23,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3567.26,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2704.98,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3394.84,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2728.72,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2614.52,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":948.41,"methodology":"other"},{"payer_name":"Old Surety Life","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4819.13,"methodology":"other"},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24300.75,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2605.03,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2714.14,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4489.24,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3752.57,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5019.14,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2741.95,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3758.31,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3594.18,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3464.73,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2797.9,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4819.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"minimum":3250.92,"maximum":27374.99,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4806.01,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4805.51,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7082.03,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5554.88,"methodology":"other"},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4806.01,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13767.8,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5986.46,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13794.76,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27374.99,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4806.01,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3721.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4819.13,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4806.01,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4870.86,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4805.6,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4791.48,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7973.01,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7155.83,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6119.98,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4931.59,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4762.53,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4478.04,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4659.56,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6853.51,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4806.02,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3250.92,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4786.48,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4193.45,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4350.45,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5378.48,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4906.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"minimum":57.15,"maximum":36216.37,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9258.47,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9297.89,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9231.74,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13650.46,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13650.46,"methodology":"other"},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9245.35,"methodology":"other"},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9258.47,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14730.2,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13766.8,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9231.53,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9312.71,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13800.16,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21090.65,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36216.37,"methodology":"other"},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9258.47,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9323.98,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9263.7,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5707.79,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.15,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4650.73,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9258.47,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9231.33,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9233.33,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9320.79,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9284.32,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9231.83,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9228.83,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9231.83,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9219.28,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9414.11,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9414.11,"methodology":"other"},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14883.96,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":488.67,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20883.38,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12115.38,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9725.4,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11997.34,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9258.47,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9645.95,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8203.16,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10184.62,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9248.64,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19864.2,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9230.44,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10162.36,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3688.28,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7540.38,"methodology":"other"},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9323.98,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9414.11,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":325.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"minimum":2336.38,"maximum":49196.85,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14730.2,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14703.47,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21736.68,"methodology":"other"},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14730.2,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14693.85,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13806.83,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49196.85,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2347.47,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8877.29,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2336.38,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14730.2,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7489.03,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14705.06,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14703.46,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14997.51,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15090.96,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27139.37,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14938.94,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15737.61,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24464.42,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14757.51,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5058.3,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14997.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Electrophysiologic Procedures","code_information":[{"code":"5212","type":"APC"}],"standard_charges":[{"minimum":3873.97,"maximum":16540.16,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6254.08,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16540.16,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3873.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6279.6,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6269.0,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6255.08,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6381.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"minimum":4813.6,"maximum":61552.6,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19921.96,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19895.22,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29447.49,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19970.5,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61552.6,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19921.96,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20943.9,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19697.84,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19921.96,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19894.82,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19896.82,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19895.32,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21211.58,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21512.81,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25406.07,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19893.92,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4828.4,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4813.6,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20295.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"minimum":716.21,"maximum":7300.38,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7120.59,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3709.18,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2307.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3816.01,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4935.0,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":716.21,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1450.61,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7143.57,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7120.04,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7120.54,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7142.17,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7300.38,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6985.24,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7140.79,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4944.7,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7259.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"minimum":300.0,"maximum":18313.49,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9046.42,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8947.71,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8948.0,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9295.7,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13780.66,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18313.49,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8978.8,"methodology":"other"},{"payer_name":"Medben","plan_name":"Medben","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":300.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8974.94,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8952.61,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9050.98,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8948.3,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8948.3,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8948.3,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9124.8,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9331.27,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8568.6,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11415.12,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8946.91,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4935.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4562.56,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9060.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"minimum":275.0,"maximum":95585.65,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16336.54,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7248.31,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4049.54,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2314.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16350.15,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":275.0,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16384.11,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16332.12,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8168.76,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16741.26,"methodology":"other"},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16350.15,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95585.65,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16335.64,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16650.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"minimum":13791.18,"maximum":20155.65,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13791.18,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19778.61,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19952.22,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19745.41,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19859.53,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20155.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"minimum":41.34,"maximum":44847.83,"setting":"outpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40784.9,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27560.11,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41.34,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43708.74,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27583.34,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5772.02,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27583.34,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27661.61,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27563.84,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28119.66,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37318.51,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29140.85,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44847.83,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":72.22,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1426.4,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28112.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"minimum":541.85,"maximum":7305.4,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":717.95,"methodology":"other"},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":723.17,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1053.1,"methodology":"other"},{"payer_name":"Joplin Claims","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1190.68,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5812.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1045.57,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7305.4,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":541.85,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2571.6,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":557.61,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1242.7,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1141.46,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":888.28,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":569.20,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"minimum":4.0,"maximum":6481.0,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":762.22,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":766.64,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":851.2,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3817.71,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1123.18,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3840.47,"methodology":"other"},{"payer_name":"American Family Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":762.22,"methodology":"other"},{"payer_name":"Ar Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":391.73,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1990.76,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1988.26,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":764.82,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1255.52,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1989.17,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6481.0,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5229.09,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2739.66,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2320.87,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1637.66,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":763.12,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":258.33,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":223.54,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":369.86,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4.0,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1037.1,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":771.86,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":762.22,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":763.42,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":760.71,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":769.84,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":594.63,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1831.96,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":854.67,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":852.84,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":765.12,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":759.12,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":774.61,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":973.25,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3959.61,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1131.21,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":860.89,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":918.42,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":870.16,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1083.56,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":772.45,"methodology":"other"},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6252.04,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1049.55,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":751.37,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1239.38,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":969.04,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":763.72,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":774.61,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":831.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"minimum":304.42,"maximum":5361.66,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1564.26,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1641.48,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1598.38,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2357.7,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2357.7,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1599.18,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1260.87,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1993.46,"methodology":"other"},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1986.74,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2916.27,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5361.66,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1599.98,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4175.82,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1351.17,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1599.98,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":304.42,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":904.52,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":589.33,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1514.73,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1599.98,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1599.98,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1599.48,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1599.48,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1626.0,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2797.33,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1630.92,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2577.64,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1973.20,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1451.35,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1514.73,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1565.48,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3213.06,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1595.78,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3417.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1626.0,"methodology":"other"},{"payer_name":"Va Visn 16","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1629.93,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1599.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"minimum":1988.13,"maximum":15925.06,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4580.93,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3213.06,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3212.86,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2047.66,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3220.25,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1988.13,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3220.25,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3214.66,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3213.16,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3213.76,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15925.06,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4148.71,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3242.04,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4325.48,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6278.8,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3740.29,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4094.04,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3954.25,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2283.82,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4192.5,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3272.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"minimum":306.44,"maximum":5538.80,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1086.82,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":955.16,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3561.78,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1132.44,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1269.8,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1988.57,"methodology":"other"},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":768.49,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1989.13,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":765.37,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1259.81,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1990.72,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5538.80,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3344.46,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2196.85,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1446.50,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":648.05,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":765.37,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":525.84,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":306.44,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":461.1,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":765.37,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":765.37,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":765.37,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":773.02,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":765.37,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2132.02,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":765.37,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":765.38,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":974.64,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":780.99,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":780.68,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3907.31,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":967.14,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1300.91,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":795.77,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":772.04,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1095.03,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":911.28,"methodology":"other"},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":450.85,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":945.4,"methodology":"other"},{"payer_name":"Uhc 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2392.0,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1034.42,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":765.38,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2119.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":780.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"minimum":209.35,"maximum":6947.92,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1373.36,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":988.23,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1367.8,"methodology":"other"},{"payer_name":"All Savers Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3986.5,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1462.17,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1462.17,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1987.52,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1989.27,"methodology":"other"},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1986.74,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":988.22,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1259.85,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1990.76,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3850.5,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6947.92,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2428.22,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2392.0,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2108.09,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1182.30,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1370.12,"methodology":"other"},{"payer_name":"Medben","plan_name":"Medben","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":988.22,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1050.70,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":634.12,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":969.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":992.26,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":988.22,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":988.22,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":998.1,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":988.22,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":988.22,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":988.22,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":988.22,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":988.23,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1008.39,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.7,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1191.38,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5048.52,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3976.48,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1962.25,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1070.58,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1495.56,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1388.98,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2233.1,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1557.02,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1770.72,"methodology":"other"},{"payer_name":"Old Surety Life","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1371.97,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2002.93,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1371.97,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.04,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1261.5,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1974.67,"methodology":"other"},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.35,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2933.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2212.70,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1009.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"minimum":2356.74,"maximum":4815.43,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2356.74,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3479.01,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4304.35,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4815.43,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2360.93,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3042.30,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2521.54,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2547.77,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4000.27,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2587.0,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2867.05,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3366.18,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3417.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2399.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complex GI Procedures","code_information":[{"code":"5331","type":"APC"}],"standard_charges":[{"minimum":2519.17,"maximum":7522.64,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4778.62,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7061.67,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4870.12,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2519.17,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7522.64,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7001.49,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4792.2,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4778.22,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4776.82,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6130.57,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7350.41,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2584.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4870.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"minimum":295.0,"maximum":28854.51,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2909.06,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":295.0,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4286.72,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4292.42,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2181.73,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6375.48,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2906.00,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7979.52,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6842.32,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28019.4,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3357.58,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1404.28,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2909.06,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2904.73,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2903.23,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2903.23,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28854.51,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5145.02,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3226.19,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4789.84,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3700.87,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3177.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1704.54,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2972.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"minimum":480.87,"maximum":8037.21,"setting":"outpatient","payers_information":[{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":480.87,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8037.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"minimum":60.78,"maximum":36755.79,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4851.68,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5416.52,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4837.86,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16032.74,"methodology":"other"},{"payer_name":"All Savers Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36755.79,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7149.33,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7149.33,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22100.28,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14525.91,"methodology":"other"},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14579.88,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4837.66,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7974.87,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14526.14,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15008.66,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6919.5,"methodology":"other"},{"payer_name":"Cox Health Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9326.72,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7500.0,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10380.06,"methodology":"other"},{"payer_name":"Img","plan_name":"Img","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4556.72,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8225.00,"methodology":"other"},{"payer_name":"Mancare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2292.6,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4851.68,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":780.49,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":899.84,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1151.58,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5552.75,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60.78,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4851.68,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4837.46,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4839.46,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4886.28,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4837.96,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4831.96,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4837.96,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4930.57,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1392.27,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2476.54,"methodology":"other"},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4845.77,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5666.42,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17748.38,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6162.98,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4891.56,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5025.2,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4821.7,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4901.51,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4636.28,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5059.21,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4851.68,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4782.65,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4201.00,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4533.03,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5134.56,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6168.14,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4831.96,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5245.0,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3065.4,"methodology":"other"},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6168.14,"methodology":"other"},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4106.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4107.86,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5544.78,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4326.02,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4110.83,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4930.57,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4930.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"minimum":534.15,"maximum":34232.76,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9683.34,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":534.15,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12754.48,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12754.48,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14562.04,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9067.74,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7981.41,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14558.92,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9654.1,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14096.84,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1402.98,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8655.45,"methodology":"other"},{"payer_name":"Medi Share","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8829.28,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5614.02,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8652.91,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8625.77,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8712.47,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8426.56,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8626.27,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8624.27,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8105.33,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34232.76,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10901.34,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8881.3,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8881.61,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9327.47,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8105.33,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1677.82,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8741.10,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8532.3,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11004.03,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4593.12,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4137.09,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4211.08,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8798.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"minimum":207.81,"maximum":344.12,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":207.81,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":344.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"minimum":439.03,"maximum":5946.42,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2117.48,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5946.42,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":574.39,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":439.03,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":488.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"minimum":300.0,"maximum":6193.29,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1670.31,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1711.59,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2123.99,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3828.72,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1711.39,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2322.85,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3826.83,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6193.29,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2398.94,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1522.88,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1712.65,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1711.19,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1729.78,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1711.69,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1711.19,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":300.0,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5543.63,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2424.39,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2255.45,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":985.72,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1783.23,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1639.36,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1621.4,"methodology":"other"},{"payer_name":"Uhc 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2392.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1740.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"minimum":540.66,"maximum":26584.5,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2925.32,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4319.54,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4319.54,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2905.0,"methodology":"other"},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17640.17,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18707.39,"methodology":"other"},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6443.62,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2925.11,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3782.81,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6384.45,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26584.5,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8594.78,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2931.33,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2931.33,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":540.66,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":632.95,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2778.85,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2931.33,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2924.41,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2926.91,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2960.64,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2925.41,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2925.41,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2919.42,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2978.99,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20078.51,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3798.10,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5505.85,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6210.4,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3480.75,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3242.38,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2615.43,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2789.26,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2721.34,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2925.38,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2586.58,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4106.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4028.09,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2978.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"minimum":2235.5,"maximum":20272.02,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4350.84,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4339.06,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6411.31,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6380.72,"methodology":"other"},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4350.84,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6377.34,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4338.71,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3779.73,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6383.46,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20272.02,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7765.62,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6718.54,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8874.14,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4350.84,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4335.16,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2235.5,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4350.84,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4338.66,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4340.66,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4389.03,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4339.16,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4339.11,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4335.16,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5318.63,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5716.82,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6564.94,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5332.85,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6391.36,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6400.64,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3821.88,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4137.17,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4432.33,"methodology":"other"},{"payer_name":"Uhc 30573","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4193.06,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5531.41,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4350.85,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4320.5,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3809.26,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4508.29,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4350.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 8 Urology and Related Services","code_information":[{"code":"5378","type":"APC"}],"standard_charges":[{"minimum":16860.07,"maximum":17779.16,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16860.07,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17779.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"minimum":220.36,"maximum":3428.18,"setting":"outpatient","payers_information":[{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":246.91,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":249.81,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":236.30,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3428.18,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":395.19,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":456.04,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":220.36,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3326.20,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":291.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"minimum":272.99,"maximum":3826.19,"setting":"outpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":397.49,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3826.19,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":272.99,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":641.64,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":963.89,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":451.21,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":509.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Gynecologic Procedures","code_information":[{"code":"5413","type":"APC"}],"standard_charges":[{"minimum":810.85,"maximum":6371.76,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6371.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":810.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"minimum":1085.77,"maximum":10446.0,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2584.0,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2481.56,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2624.01,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3873.73,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3873.73,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3834.0,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2623.81,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2319.7,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3829.73,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8357.0,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10446.0,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7041.71,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5089.39,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1085.77,"methodology":"other"},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3272.22,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2628.8,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2628.8,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2624.36,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2624.11,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3549.88,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2685.14,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3002.86,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3062.88,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2819.1,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2591.39,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4274.47,"methodology":"other"},{"payer_name":"Uhc 30573","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2831.03,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3342.1,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2584.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2763.49,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2584.0,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2671.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"minimum":3171.0,"maximum":36290.4,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3171.0,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5890.42,"methodology":"other"},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36290.4,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6162.95,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6401.65,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3713.84,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6374.28,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16335.83,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4182.77,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4172.8,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4212.95,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4182.3,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4113.38,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4265.95,"methodology":"other"},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4182.3,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18247.88,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6435.56,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4316.54,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5523.98,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5036.36,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6800.51,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3171.0,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3171.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3251.79,"methodology":"other"},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4122.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 6 Gynecologic Procedures","code_information":[{"code":"5416","type":"APC"}],"standard_charges":[{"minimum":6387.76,"maximum":6457.21,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6387.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6399.86,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6457.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"minimum":426.4,"maximum":5308.42,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2879.0,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1577.63,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1622.3,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5308.42,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2392.34,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2392.34,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2535.72,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3818.03,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1622.59,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2311.05,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3819.52,"methodology":"other"},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4194.0,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4661.24,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":949.14,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3176.42,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2789.62,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1577.63,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1623.49,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":426.4,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":427.39,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":476.98,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2309.44,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1540.17,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1623.49,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1622.39,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1624.39,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1639.05,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1622.89,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1622.89,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1617.3,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1649.89,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1649.89,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5126.45,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2026.62,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1634.47,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1646.84,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1571.61,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1623.49,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1536.98,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1600.39,"methodology":"other"},{"payer_name":"Uhc 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3954.25,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2364.6,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1649.89,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1616.9,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2743.5,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2587.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3954.25,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2587.0,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3954.25,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3954.25,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1649.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"minimum":4.0,"maximum":3832.68,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":387.14,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":242.51,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":254.71,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1794.99,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":369.37,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3832.68,"methodology":"other"},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":360.19,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2922.55,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":253.09,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2313.36,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3827.07,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1293.5,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2433.07,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":313.0,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.66,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.66,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":254.74,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":253.09,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":254.74,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":253.09,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":251.68,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":251.7,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":253.09,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3521.12,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":313.42,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.73,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":255.56,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":241.09,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":255.34,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":235.77,"methodology":"other"},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":252.88,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":246.96,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":404.94,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.68,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":319.43,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":252.63,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":328.98,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":253.09,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":332.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":254.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"minimum":317.80,"maximum":3835.31,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":565.51,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":569.12,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":585.03,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3701.07,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":856.86,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3834.09,"methodology":"other"},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":569.12,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3816.0,"methodology":"other"},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3817.49,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":579.92,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2325.23,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3826.7,"methodology":"other"},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3835.31,"methodology":"other"},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2796.0,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2683.67,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2124.49,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1201.39,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1962.76,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":581.48,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":342.86,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":518.56,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":317.80,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":581.48,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":584.62,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":586.62,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":590.18,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":587.3,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":585.12,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":579.12,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":585.12,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":580.94,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":590.94,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":590.94,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":596.7,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3791.54,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":731.77,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":595.66,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":590.31,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":562.9,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":581.48,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1309.16,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":550.5,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1414.02,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":565.51,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":573.94,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":945.5,"methodology":"other"},{"payer_name":"Uhc 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":581.49,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":739.27,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":579.38,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":590.94,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":592.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"minimum":58.5,"maximum":3843.28,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1894.0,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":766.42,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1123.24,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":774.45,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58.5,"methodology":"other"},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1149.63,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1561.07,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1698.85,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3822.62,"methodology":"other"},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1121.9,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3818.02,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1150.14,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2314.36,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3817.65,"methodology":"other"},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2796.0,"methodology":"other"},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1152.88,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3355.5,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1249.71,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1930.88,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2677.75,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1541.75,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":944.16,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1152.88,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":483.78,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1757.35,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":414.34,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":725.58,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":770.85,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1152.88,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":774.62,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":759.79,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":236.67,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1121.9,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":769.3,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1150.95,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":845.9,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1171.62,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1171.62,"methodology":"other"},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":766.42,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3843.28,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":957.52,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1157.4,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":780.74,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":736.55,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1149.63,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":725.58,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":934.92,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1133.27,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1246.21,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1152.88,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":489.25,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":767.91,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1820.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2677.75,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2640.12,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1168.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"minimum":581.51,"maximum":2907.53,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2857.28,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2855.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2861.01,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":581.51,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2907.53,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2907.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Neurostimulator and Related Procedures","code_information":[{"code":"5462","type":"APC"}],"standard_charges":[{"minimum":375.0,"maximum":19997.9,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5778.34,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8474.08,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8474.08,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5727.91,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19997.9,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5750.68,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5732.81,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":375.0,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5844.19,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5900.95,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5444.26,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5848.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Neurostimulator and Related Procedures","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"minimum":18324.75,"maximum":27105.01,"setting":"outpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27105.01,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20006.56,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18351.89,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18324.75,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18874.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Neurostimulator and Related Procedures","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"minimum":7299.93,"maximum":89659.68,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25839.08,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26009.97,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38222.55,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37152.58,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26060.19,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36231.18,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37150.40,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7299.93,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26036.7,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26110.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26036.7,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26009.56,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26011.06,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26010.06,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":89659.68,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26844.86,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25423.81,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26036.7,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16764.0,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24766.64,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25738.72,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33194.98,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35005.27,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26534.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5503","type":"APC"}],"standard_charges":[{"minimum":1907.47,"maximum":8004.3,"setting":"outpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2895.42,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1964.89,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1907.47,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8004.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"minimum":21.06,"maximum":4857.0,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":253.36,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.41,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.4,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.4,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna 14079","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":421.74,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":421.74,"methodology":"other"},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4857.0,"methodology":"other"},{"payer_name":"All Savers Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":566.0,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":112.59,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":112.59,"methodology":"other"},{"payer_name":"Ar Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":89.48,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.15,"methodology":"other"},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21.58,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.38,"methodology":"other"},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29.7,"methodology":"other"},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29.7,"methodology":"other"},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.41,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.65,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40.86,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40.86,"methodology":"other"},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.41,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114.64,"methodology":"other"},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1115.01,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":181.12,"methodology":"other"},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":130.44,"methodology":"other"},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":349.0,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":145.44,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":196.43,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":233.44,"methodology":"other"},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59.4,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.55,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":351.71,"methodology":"other"},{"payer_name":"Goldins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":266.08,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":173.16,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.74,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.25,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.41,"methodology":"other"},{"payer_name":"Medben","plan_name":"Medben","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.65,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.74,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.74,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.74,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.81,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.14,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21.06,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.41,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.41,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.1,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.18,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.64,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.65,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.1,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.65,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.43,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.65,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.65,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.18,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.62,"methodology":"other"},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.1,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":967.28,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":421.74,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.62,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78.09,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.6,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.09,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":484.69,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70.48,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.38,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.43,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.28,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78.09,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":171.5,"methodology":"other"},{"payer_name":"Tribal Member","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.41,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.25,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.32,"methodology":"other"},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":382.69,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":124.24,"methodology":"other"},{"payer_name":"Uhc 30573","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":231.1,"methodology":"other"},{"payer_name":"Uhc 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":246.50,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.85,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.41,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.14,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.4,"methodology":"other"},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.14,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":347.28,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.55,"methodology":"other"},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.55,"methodology":"other"},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":160.9,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.55,"methodology":"other"},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":242.46,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.55,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.55,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":351.71,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.55,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.65,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"minimum":40.89,"maximum":2480.0,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.15,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.8,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.95,"methodology":"other"},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.15,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.95,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna 14079","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":666.69,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":886.08,"methodology":"other"},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.48,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.23,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.23,"methodology":"other"},{"payer_name":"Ar Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":69.0,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.95,"methodology":"other"},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.87,"methodology":"other"},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.8,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":121.02,"methodology":"other"},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85.07,"methodology":"other"},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":390.66,"methodology":"other"},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":171.82,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.95,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":91.56,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":112.77,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":294.51,"methodology":"other"},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":327.24,"methodology":"other"},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":224.18,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":265.88,"methodology":"other"},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":790.47,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":584.0,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":199.92,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":490.46,"methodology":"other"},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.45,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.15,"methodology":"other"},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.8,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.15,"methodology":"other"},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":790.47,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":213.76,"methodology":"other"},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":217.63,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59.96,"methodology":"other"},{"payer_name":"Mancare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2480.0,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.8,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.45,"methodology":"other"},{"payer_name":"Medben","plan_name":"Medben","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":168.17,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59.96,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59.96,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59.96,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49.57,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40.89,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73.06,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.45,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":141.46,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.45,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.07,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.37,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.37,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":146.70,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.95,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.88,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.95,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.68,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.95,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.95,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.8,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.83,"methodology":"other"},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.07,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":744.79,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":617.52,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":120.09,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96.08,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.92,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.38,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":281.58,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":657.08,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85.19,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71.38,"methodology":"other"},{"payer_name":"Old Surety Life","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.45,"methodology":"other"},{"payer_name":"Psu Athletics","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1222.24,"methodology":"other"},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":483.0,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96.08,"methodology":"other"},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":122.14,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.8,"methodology":"other"},{"payer_name":"Tricare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":91.13,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.33,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":91.13,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":150.32,"methodology":"other"},{"payer_name":"Uhc 30573","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.92,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.15,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.45,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":117.53,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.08,"methodology":"other"},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.15,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":213.22,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.15,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.15,"methodology":"other"},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.15,"methodology":"other"},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.15,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.15,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.15,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.15,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.15,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.95,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"minimum":120.75,"maximum":4036.5,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":521.08,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.04,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":208.21,"methodology":"other"},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":324.96,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":208.71,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3199.35,"methodology":"other"},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3339.31,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":303.62,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":303.62,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":203.12,"methodology":"other"},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":204.96,"methodology":"other"},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":178.51,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":228.43,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.1,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":180.28,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":228.43,"methodology":"other"},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3009.34,"methodology":"other"},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":228.93,"methodology":"other"},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.58,"methodology":"other"},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4036.5,"methodology":"other"},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":228.93,"methodology":"other"},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":831.11,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":893.52,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":919.18,"methodology":"other"},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.04,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":661.68,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1721.10,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.58,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":426.13,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":466.94,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":259.29,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":213.75,"methodology":"other"},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.04,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.04,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.04,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":131.0,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":131.0,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":131.0,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":120.75,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":195.06,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.04,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.04,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":208.4,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":211.48,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":208.1,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.04,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.39,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":205.2,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.39,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":205.81,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.39,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.39,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.04,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":210.31,"methodology":"other"},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":650.83,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3187.37,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":262.38,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.9,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":213.94,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":201.83,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":219.16,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":231.84,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":267.09,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":171.37,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138.8,"methodology":"other"},{"payer_name":"Psu Athletics","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.58,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.9,"methodology":"other"},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3009.34,"methodology":"other"},{"payer_name":"Student Insurance","plan_name":"Student Insurance","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":228.93,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.04,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.83,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":203.11,"methodology":"other"},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.39,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.39,"methodology":"other"},{"payer_name":"Uhc 30573","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":349.79,"methodology":"other"},{"payer_name":"Uhc 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.58,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.58,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":207.72,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":261.95,"methodology":"other"},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.58,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":205.21,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.58,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.58,"methodology":"other"},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.58,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.58,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.58,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.58,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.58,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.58,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.39,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"minimum":93.4,"maximum":3483.97,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.4,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":463.88,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":464.4,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":465.5,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna 14079","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3426.0,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2432.46,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":683.56,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":683.56,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1547.96,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1759.23,"methodology":"other"},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1177.07,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":463.89,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1096.54,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1177.07,"methodology":"other"},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1177.07,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2028.19,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2028.19,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":463.88,"methodology":"other"},{"payer_name":"Cox Health Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2633.78,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1346.42,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":467.0,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":405.0,"methodology":"other"},{"payer_name":"Goldins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":493.9,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":946.13,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":583.77,"methodology":"other"},{"payer_name":"Joplin Claims","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":261.95,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":462.99,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":575.03,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":463.88,"methodology":"other"},{"payer_name":"Medben","plan_name":"Medben","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":755.99,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":231.01,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":281.47,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.21,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":198.98,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":107.4,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":273.28,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":463.88,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":462.59,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":462.79,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":472.61,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":463.79,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":463.89,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":462.96,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":462.6,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":471.42,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":471.42,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":484.54,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":472.23,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3483.97,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":583.77,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":503.92,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":475.99,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":537.67,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1399.58,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":618.37,"methodology":"other"},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1056.46,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":189.64,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.67,"methodology":"other"},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2932.3,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":503.92,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":441.58,"methodology":"other"},{"payer_name":"Tribal Member","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.0,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":457.28,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":754.27,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":572.58,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":466.5,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":589.75,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":462.0,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":558.53,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":467.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":467.0,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":467.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":467.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":471.42,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":615.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"minimum":83.01,"maximum":6598.91,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":196.41,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":267.82,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":159.74,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.0,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3478.02,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":227.65,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":556.08,"methodology":"other"},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":377.36,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":521.53,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":332.58,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.0,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":317.13,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":398.97,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1151.95,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1396.10,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1110.88,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":158.28,"methodology":"other"},{"payer_name":"Cox Health Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2257.71,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1853.68,"methodology":"other"},{"payer_name":"Goldins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":729.86,"methodology":"other"},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":154.49,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":371.52,"methodology":"other"},{"payer_name":"Joplin Claims","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":242.72,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":238.27,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":158.28,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":155.77,"methodology":"other"},{"payer_name":"Medben","plan_name":"Medben","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":156.68,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":189.61,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":109.90,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":144.33,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":151.12,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":83.01,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":154.49,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.00,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":199.23,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":158.57,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":382.26,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.0,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.0,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":237.63,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.0,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":154.46,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":383.5,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.0,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":158.08,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6598.91,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":202.63,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":162.1,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":165.22,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":160.48,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":159.54,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":382.09,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":152.47,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":108.08,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":409.14,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":158.28,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":152.29,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":251.21,"methodology":"other"},{"payer_name":"Uhc 30573","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":479.7,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":355.4,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":155.74,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":196.41,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":156.86,"methodology":"other"},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":239.85,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":244.97,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":311.68,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":484.86,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":239.85,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.0,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":196.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"minimum":146.74,"maximum":5208.39,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":323.36,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":324.55,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":325.56,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5180.52,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":476.51,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":476.51,"methodology":"other"},{"payer_name":"Ar Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":146.74,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":396.06,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":366.03,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":325.96,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":468.25,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":494.36,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1171.0,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1084.52,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1277.5,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":490.01,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2720.45,"methodology":"other"},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":402.54,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":490.01,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":490.01,"methodology":"other"},{"payer_name":"Goldins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":490.01,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":942.08,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":483.56,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":481.64,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":323.37,"methodology":"other"},{"payer_name":"Medben","plan_name":"Medben","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":328.06,"methodology":"other"},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":276.38,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.69,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.69,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.69,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":302.04,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":183.49,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":193.06,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":323.37,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":324.86,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":325.26,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":331.28,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":328.06,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":322.06,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":328.06,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":322.66,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":328.63,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":328.63,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":412.26,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5208.39,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":413.96,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":331.17,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":342.43,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":318.43,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":328.62,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":191.92,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":188.8,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":323.36,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":318.77,"methodology":"other"},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3571.27,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":328.63,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":490.01,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":411.12,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":322.66,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":490.01,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":490.01,"methodology":"other"},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":726.23,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":492.57,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":490.01,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":495.13,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":495.13,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":490.01,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":328.63,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":537.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"minimum":92.94,"maximum":21127.85,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":752.61,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":647.89,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":671.52,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5808.22,"methodology":"other"},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21127.85,"methodology":"other"},{"payer_name":"All Savers Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":313.0,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":992.09,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1468.6,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3858.73,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1978.75,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":672.42,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2717.83,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2002.18,"methodology":"other"},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":971.68,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.94,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2182.70,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2506.17,"methodology":"other"},{"payer_name":"First Agency","plan_name":"First Agency","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3848.94,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1423.89,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":673.25,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":415.56,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":452.14,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":422.71,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":673.25,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":673.25,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":833.55,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":683.22,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1006.59,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":672.32,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":672.42,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":671.52,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":671.02,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1054.89,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1012.83,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":684.92,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4339.88,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1250.24,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":997.01,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1016.18,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":961.72,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":695.68,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":289.55,"methodology":"other"},{"payer_name":"Psu Athletics","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3845.97,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1059.32,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":663.67,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":230.0,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":313.0,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":674.33,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":855.93,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":670.52,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":467.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":467.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":467.0,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":467.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":467.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":684.2,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1012.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"minimum":36.86,"maximum":2082.43,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":516.94,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":341.13,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.4,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.9,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna 14079","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1608.15,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1608.15,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":511.04,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":511.04,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":767.32,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":360.90,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":347.64,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":696.31,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":784.29,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1210.83,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1066.68,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":475.82,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":346.8,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":218.05,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":278.01,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":218.05,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36.86,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":191.52,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":221.18,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":346.8,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.63,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.19,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.59,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":354.84,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":354.44,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":346.8,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":350.29,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":351.29,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":346.0,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":352.44,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":358.3,"methodology":"other"},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":346.8,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2082.43,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":436.72,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":349.38,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":356.1,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":335.94,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":167.71,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":224.66,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":349.38,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":341.87,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":563.9,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":516.94,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":440.9,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":346.9,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":516.94,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":516.94,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":516.94,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":516.94,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":352.44,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":606.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"minimum":283.02,"maximum":2504.17,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":442.78,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":455.89,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2504.17,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":669.71,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":669.71,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":526.34,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":450.06,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":454.83,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":430.71,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":526.34,"methodology":"other"},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":526.34,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1606.8,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1606.8,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1386.11,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1089.31,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":454.48,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":283.02,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":454.48,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":454.48,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":457.98,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":457.53,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":627.80,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":453.24,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":639.22,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":566.85,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":457.57,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":462.2,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":439.97,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":422.47,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":307.35,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":307.35,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":448.01,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":738.99,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":670.99,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":577.8,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":454.48,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":670.99,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":670.99,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":670.99,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":462.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"minimum":335.4,"maximum":11658.87,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1472.58,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1232.18,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1176.70,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1192.63,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9691.76,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1759.42,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1759.42,"methodology":"other"},{"payer_name":"Ar Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":344.72,"methodology":"other"},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1196.62,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1317.78,"methodology":"other"},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2130.53,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1193.02,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3060.31,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2130.54,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3751.94,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2056.27,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3515.81,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1195.93,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":909.36,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":410.79,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":341.46,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1193.98,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1193.98,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1192.32,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1207.01,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1859.64,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1195.12,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1194.02,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1193.98,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1195.02,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1189.73,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1261.44,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1213.39,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1389.23,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1217.86,"methodology":"other"},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1193.98,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11658.87,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1834.71,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1444.8,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1495.99,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1411.31,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1194.62,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":739.17,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":335.4,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1941.42,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2199.89,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1193.98,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1607.14,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1189.73,"methodology":"other"},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2056.27,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2056.27,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2056.27,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2056.27,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2034.27,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1213.39,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1899.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"minimum":102.77,"maximum":12870.25,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1307.16,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1304.35,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1313.13,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9021.35,"methodology":"other"},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1315.47,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1938.45,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1938.45,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3090.84,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1727.84,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1314.02,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2721.36,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3090.84,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3688.9,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1315.47,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5058.01,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2285.42,"methodology":"other"},{"payer_name":"Goldins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1980.84,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3781.2,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1655.46,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":983.67,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1307.16,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1315.47,"methodology":"other"},{"payer_name":"Medben","plan_name":"Medben","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1316.12,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1265.95,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1148.1,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":835.53,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":102.77,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1198.46,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1315.47,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1312.92,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1313.32,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1329.23,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1324.42,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1315.47,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1316.12,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1310.12,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1316.12,"methodology":"other"},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1315.47,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1310.73,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1336.86,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1336.86,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1341.33,"methodology":"other"},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1315.12,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9137.88,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1673.44,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1338.75,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1364.5,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1287.26,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1315.47,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4267.91,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1198.46,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1226.22,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1307.16,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1309.18,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1296.75,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5638.43,"methodology":"other"},{"payer_name":"Uhc 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12870.25,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1980.84,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1672.41,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1310.13,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1980.84,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1980.84,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1980.84,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1980.84,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1980.84,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1336.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"minimum":1097.20,"maximum":1097.20,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1097.20,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"minimum":1488.47,"maximum":1488.47,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1488.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"minimum":413.96,"maximum":1405.14,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":649.46,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":413.96,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1180.03,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":655.27,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":468.6,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":606.12,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1405.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 6 Radiation Therapy","code_information":[{"code":"5626","type":"APC"}],"standard_charges":[{"minimum":1649.62,"maximum":1649.62,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1649.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"minimum":14.04,"maximum":424.94,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":200.56,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43.83,"methodology":"other"},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":109.71,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.38,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna 14079","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":424.94,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":202.35,"methodology":"other"},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":341.14,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67.14,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67.14,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.12,"methodology":"other"},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.12,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.36,"methodology":"other"},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.36,"methodology":"other"},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.12,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.37,"methodology":"other"},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.06,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58.36,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.12,"methodology":"other"},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.06,"methodology":"other"},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.12,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81.8,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.34,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.79,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73.52,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":218.51,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.14,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":150.42,"methodology":"other"},{"payer_name":"Goldins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58.61,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":193.62,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":261.88,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.3,"methodology":"other"},{"payer_name":"Medi Share","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.56,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.2,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.2,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":130.94,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14.04,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.8,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.8,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.56,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.37,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.37,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.82,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.82,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.37,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.37,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.37,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.37,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.68,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.3,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.3,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.29,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":202.35,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114.66,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90.13,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":91.86,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":88.2,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":222.36,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":72.88,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":72.88,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":91.73,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44.91,"methodology":"other"},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70.86,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.08,"methodology":"other"},{"payer_name":"Uhc 30573","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":100.28,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.14,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.3,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.92,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.38,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71.56,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.03,"methodology":"other"},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.14,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.14,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":100.28,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.14,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":100.28,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.3,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"minimum":66.9,"maximum":1849.46,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":143.61,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":143.04,"methodology":"other"},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":143.61,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":211.63,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":207.50,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.85,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":807.53,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":248.94,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":500.66,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1849.46,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":435.43,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":445.58,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":159.76,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":255.62,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1500.0,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66.9,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":143.61,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":149.91,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":143.03,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138.83,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":143.03,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":143.03,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":145.95,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":880.84,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":466.05,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":321.61,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":373.73,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":439.23,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":147.08,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":186.42,"methodology":"other"},{"payer_name":"Tribal Member","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":284.83,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":678.78,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":143.04,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":900.67,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":458.09,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":517.35,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"minimum":210.56,"maximum":2926.35,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":709.72,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":301.02,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":445.38,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":242.24,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":383.83,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":356.70,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":331.90,"methodology":"other"},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":210.56,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":369.36,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":284.46,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1044.88,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2166.44,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":220.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":302.25,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":284.46,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":301.02,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":301.02,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":301.02,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":307.16,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":364.17,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":297.88,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":408.8,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":439.42,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":248.41,"methodology":"other"},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2439.03,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":302.25,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1445.0,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2926.35,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":471.76,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":324.11,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":596.21,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":442.17,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":307.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"minimum":702.88,"maximum":2518.89,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":720.09,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":702.88,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2518.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"minimum":150.68,"maximum":7001.08,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6002.91,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3060.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6002.38,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1561.25,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7001.08,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":369.58,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":589.44,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1443.61,"methodology":"other"},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":543.63,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3208.52,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":150.68,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2294.71,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1469.8,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2251.60,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1360.16,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2577.29,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2278.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3061.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1058.76,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4060.52,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2152.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"minimum":56.08,"maximum":922.12,"setting":"outpatient","payers_information":[{"payer_name":"All Savers Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":417.58,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":332.12,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":65.1,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59.24,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":922.12,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":155.76,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":179.72,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"minimum":40.0,"maximum":6502.99,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":360.46,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.59,"methodology":"other"},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":274.72,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":429.37,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":324.44,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6502.99,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":224.24,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":337.09,"methodology":"other"},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":351.5,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":918.5,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":283.99,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":219.40,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":291.38,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":444.66,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40.0,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":223.78,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":117.56,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":223.78,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":355.38,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1644.24,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":902.99,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":441.0,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":616.18,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":462.7,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1484.34,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":471.00,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":223.78,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":561.63,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":296.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"minimum":554.64,"maximum":997.84,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":554.64,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":636.4,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":802.04,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":997.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"minimum":35.44,"maximum":2006.0,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":179.50,"methodology":"other"},{"payer_name":"All Savers Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":163.4,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":193.55,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":656.0,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2006.0,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":820.0,"methodology":"other"},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":820.0,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":131.81,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1910.25,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1910.25,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1079.51,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1130.87,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":682.44,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":223.25,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35.44,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":131.34,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":131.41,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":161.41,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":130.81,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":130.81,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":131.17,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1424.26,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":165.3,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":130.72,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":134.78,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.15,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":130.72,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":129.48,"methodology":"other"},{"payer_name":"Uhc 30573","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1614.0,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1836.0,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":166.98,"methodology":"other"},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1749.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1749.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1749.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":133.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"minimum":46.46,"maximum":1841.68,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":356.37,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.85,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.85,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1332.14,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":388.9,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":682.2,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1073.21,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1105.52,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":262.85,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":741.77,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1073.24,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":782.62,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":933.89,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":864.26,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":599.5,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1841.68,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":332.14,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.92,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.46,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101.68,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101.68,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":555.25,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.92,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.92,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.55,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":266.17,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":270.4,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":752.41,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":262.85,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":262.85,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.35,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":268.21,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":268.21,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":455.33,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":306.91,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":938.62,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":332.14,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":265.71,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":316.89,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":363.94,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":245.11,"methodology":"other"},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":245.8,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":335.84,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":177.49,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":258.72,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":245.8,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":321.46,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":260.16,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":429.14,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":335.53,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.92,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":585.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":287.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":273.0,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":280.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":273.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":268.21,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":363.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"minimum":12.51,"maximum":1868.43,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":313.0,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":449.85,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":664.11,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":664.11,"methodology":"other"},{"payer_name":"Ar Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.11,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":452.62,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1865.64,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1868.43,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1351.67,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":450.68,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":931.69,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":526.77,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12.51,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":450.68,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":456.35,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":300.0,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":616.48,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":567.16,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":460.77,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":502.19,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":471.42,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":313.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":458.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"minimum":96.24,"maximum":5432.75,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1749.0,"methodology":"other"},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":849.61,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":876.57,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":876.57,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4576.48,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1295.47,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1295.47,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4928.90,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":879.14,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3015.0,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5432.75,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3216.18,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3038.0,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2412.53,"methodology":"other"},{"payer_name":"Goldins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":936.75,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1743.32,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":879.14,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":471.50,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4548.0,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":879.14,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":877.66,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":876.26,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":887.51,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":878.24,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":877.56,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":875.57,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":893.43,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":893.43,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":863.88,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4358.51,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1049.88,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":839.9,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":902.11,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":807.6,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":412.29,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":423.13,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":839.9,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":866.63,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1117.68,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":875.82,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1749.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1321.22,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1749.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1749.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":893.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"minimum":18.28,"maximum":183.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna 14079","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.32,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":183.89,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36.89,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.84,"methodology":"other"},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36.67,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18.28,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23.22,"methodology":"other"},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23.22,"methodology":"other"},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55.1,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39.89,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.46,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85.12,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20.27,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20.27,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20.27,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19.62,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19.94,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.08,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44.87,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.73,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43.14,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49.92,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.46,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.66,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44.87,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.68,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49.92,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49.92,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25.44,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"minimum":32.65,"maximum":568.13,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":568.13,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33.72,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34.18,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42.45,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32.65,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":102.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"minimum":5.31,"maximum":5079.13,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.43,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.65,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.23,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1651.46,"methodology":"other"},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.43,"methodology":"other"},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.43,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.79,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":261.22,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":261.22,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.27,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":229.49,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":229.49,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":193.87,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":160.74,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.43,"methodology":"other"},{"payer_name":"Medben","plan_name":"Medben","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.43,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35.76,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35.76,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20.86,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":309.89,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12.8,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53.81,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.43,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.82,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.92,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.18,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.82,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.22,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.23,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.27,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.27,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59.56,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":276.19,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":86.02,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.78,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61.46,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.61,"methodology":"other"},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":155.41,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.31,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.78,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5079.13,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.43,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":218.0,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58.12,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87.48,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58.28,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.08,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":213.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":208.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":234.9,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.27,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":106.50,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"minimum":32.61,"maximum":2111.2,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":107.98,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1775.54,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":158.28,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":158.28,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":298.77,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":106.98,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1208.61,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":583.82,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2111.2,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":109.16,"methodology":"other"},{"payer_name":"Medben","plan_name":"Medben","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":106.98,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":152.69,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90.57,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32.61,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":107.41,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":107.46,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":106.98,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":108.49,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":106.98,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":106.98,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":107.78,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":106.98,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":107.48,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":109.16,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":109.16,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":199.89,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":159.91,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":205.34,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":229.14,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":228.06,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":105.89,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.56,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":106.98,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":291.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1222.5,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":721.27,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":291.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":109.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"minimum":30.7,"maximum":222.51,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":222.51,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32.15,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.7,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.7,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32.18,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.72,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.58,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.46,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32.07,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30.7,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.28,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Electronic Analysis of Devices","code_information":[{"code":"5743","type":"APC"}],"standard_charges":[{"minimum":251.16,"maximum":251.16,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":251.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"minimum":111.24,"maximum":777.7,"setting":"outpatient","payers_information":[{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":679.86,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":777.7,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":225.12,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":221.3,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":222.2,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":112.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"minimum":528.66,"maximum":3966.9,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":547.24,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":550.92,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":920.86,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1278.46,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1221.52,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1848.84,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":550.72,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3426.7,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2769.4,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2047.14,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":547.24,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":552.52,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":556.47,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":551.02,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":545.02,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":550.92,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":545.42,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":556.14,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":528.66,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3966.9,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":549.62,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1820.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1083.0,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":556.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"minimum":71.15,"maximum":2702.5,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1318.92,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.96,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71.15,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":179.34,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":383.49,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2702.5,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1432.71,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1591.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Health and Behavior Services","code_information":[{"code":"5821","type":"APC"}],"standard_charges":[{"minimum":24.03,"maximum":24.03,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infliximab not biosimil 10mg","code_information":[{"code":"7043","type":"APC"}],"standard_charges":[{"minimum":3.93,"maximum":5294.11,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2962.42,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5294.11,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2242.45,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alteplase recombinant","code_information":[{"code":"7048","type":"APC"}],"standard_charges":[{"minimum":1.24,"maximum":10325.98,"setting":"outpatient","payers_information":[{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10325.98,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4134.09,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2651.88,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10092.74,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7801.55,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":288.06,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1.24,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, inclisiran, 1 mg","code_information":[{"code":"9004","type":"APC"}],"standard_charges":[{"minimum":3445.97,"maximum":3450.16,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3445.97,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3450.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj tezepelumab-ekko, 1mg","code_information":[{"code":"9008","type":"APC"}],"standard_charges":[{"minimum":3828.15,"maximum":3828.15,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3828.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj risankizumab-rzaa?1 mg","code_information":[{"code":"9013","type":"APC"}],"standard_charges":[{"minimum":539.01,"maximum":8919.83,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8919.83,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":539.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, etelcalcetide, 0.1 mg","code_information":[{"code":"9031","type":"APC"}],"standard_charges":[{"minimum":1.31,"maximum":1.31,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Glucagon hydrochloride","code_information":[{"code":"9042","type":"APC"}],"standard_charges":[{"minimum":81.96,"maximum":81.96,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, lanreotide, (cipla) 1mg","code_information":[{"code":"9051","type":"APC"}],"standard_charges":[{"minimum":5542.36,"maximum":5542.36,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5542.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Thyrotropin injection","code_information":[{"code":"9108","type":"APC"}],"standard_charges":[{"minimum":1921.3,"maximum":1921.3,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1921.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, Fulvestrant","code_information":[{"code":"9120","type":"APC"}],"standard_charges":[{"minimum":265.40,"maximum":265.40,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":265.40,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Natalizumab injection","code_information":[{"code":"9126","type":"APC"}],"standard_charges":[{"minimum":1.92,"maximum":1.92,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Prothrombin complex kcentra","code_information":[{"code":"9132","type":"APC"}],"standard_charges":[{"minimum":5.25,"maximum":6384.11,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5836.85,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6384.11,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Rabies ig, im/sc","code_information":[{"code":"9133","type":"APC"}],"standard_charges":[{"minimum":425.11,"maximum":6896.95,"setting":"outpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6896.95,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6230.6,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1637.82,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4603.81,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4099.49,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":425.11,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":960.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Rabies vaccine, im","code_information":[{"code":"9139","type":"APC"}],"standard_charges":[{"minimum":413.91,"maximum":810.39,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":413.91,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":810.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj ublituximab-xiiy, 1 mg","code_information":[{"code":"9149","type":"APC"}],"standard_charges":[{"minimum":2.94,"maximum":2.94,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj midazolam (wg crit care)","code_information":[{"code":"9170","type":"APC"}],"standard_charges":[{"minimum":7.95,"maximum":7.95,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, fulphila","code_information":[{"code":"9173","type":"APC"}],"standard_charges":[{"minimum":2070.32,"maximum":2070.32,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2070.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj., rituximab, 10 mg","code_information":[{"code":"9186","type":"APC"}],"standard_charges":[{"minimum":1079.06,"maximum":1079.06,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1079.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Leuprolide acetate suspnsion","code_information":[{"code":"9217","type":"APC"}],"standard_charges":[{"minimum":593.32,"maximum":632.21,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":593.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":632.21,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":597.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, calcium gluconate, nos","code_information":[{"code":"9226","type":"APC"}],"standard_charges":[{"minimum":5.04,"maximum":5.04,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Eculizumab injection","code_information":[{"code":"9236","type":"APC"}],"standard_charges":[{"minimum":26746.61,"maximum":53598.22,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26746.61,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53598.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Calcium glucon (wg critical)","code_information":[{"code":"9238","type":"APC"}],"standard_charges":[{"minimum":5.04,"maximum":61.4,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.04,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Romiplostim injection","code_information":[{"code":"9245","type":"APC"}],"standard_charges":[{"minimum":2482.15,"maximum":2482.15,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2482.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ustekinumab sub cu inj, 1 mg","code_information":[{"code":"9261","type":"APC"}],"standard_charges":[{"minimum":1.40,"maximum":1.40,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1.40,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, denosumab","code_information":[{"code":"9272","type":"APC"}],"standard_charges":[{"minimum":332.55,"maximum":2990.08,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2990.08,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":332.55,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":870.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, bupivacaine, nos, 0.5mg","code_information":[{"code":"9290","type":"APC"}],"standard_charges":[{"minimum":2.21,"maximum":3875.78,"setting":"outpatient","payers_information":[{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3832.07,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3875.78,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2321.99,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3827.07,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2.21,"methodology":"other"},{"payer_name":"Uhc 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":542.65,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3.0,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":472.5,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":528.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, clindamycin (baxter)","code_information":[{"code":"9292","type":"APC"}],"standard_charges":[{"minimum":5.25,"maximum":313.32,"setting":"outpatient","payers_information":[{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":313.32,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, Carfilzomib, 1 mg","code_information":[{"code":"9295","type":"APC"}],"standard_charges":[{"minimum":5163.39,"maximum":5163.39,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5163.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Omalizumab injection","code_information":[{"code":"9300","type":"APC"}],"standard_charges":[{"minimum":1003.0,"maximum":1197.66,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1003.0,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1197.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj. romosozumab-aqqg 1 mg","code_information":[{"code":"9327","type":"APC"}],"standard_charges":[{"minimum":2364.16,"maximum":3226.81,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3226.81,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2364.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj truxima 10 mg","code_information":[{"code":"9336","type":"APC"}],"standard_charges":[{"minimum":2824.43,"maximum":2824.43,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2824.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj fam-trastu deru-nxki 1mg","code_information":[{"code":"9353","type":"APC"}],"standard_charges":[{"minimum":12569.38,"maximum":12569.38,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12569.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj. eptinezumab-jjmr 1 mg","code_information":[{"code":"9357","type":"APC"}],"standard_charges":[{"minimum":1.92,"maximum":5698.4,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5687.17,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5698.4,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj heparin, pfizer, 1000u","code_information":[{"code":"9360","type":"APC"}],"standard_charges":[{"minimum":5.25,"maximum":672.2,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.25,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":130.66,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":672.2,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":181.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, esmolol hcl, 10mg","code_information":[{"code":"9363","type":"APC"}],"standard_charges":[{"minimum":5.25,"maximum":5.25,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, metronidazole, 10 mg","code_information":[{"code":"9369","type":"APC"}],"standard_charges":[{"minimum":3.82,"maximum":3.82,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj. isatuximab-irfc 10 mg","code_information":[{"code":"9377","type":"APC"}],"standard_charges":[{"minimum":8803.83,"maximum":8803.83,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8803.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Daratumumab, hyaluronidase","code_information":[{"code":"9378","type":"APC"}],"standard_charges":[{"minimum":15712.02,"maximum":15712.02,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15712.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, labetalol hcl, 5mg","code_information":[{"code":"9400","type":"APC"}],"standard_charges":[{"minimum":85.25,"maximum":85.25,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj labetalol hcl hikma, 5mg","code_information":[{"code":"9402","type":"APC"}],"standard_charges":[{"minimum":5.25,"maximum":1248.38,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1248.38,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.25,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Methylnaltrexone injection","code_information":[{"code":"9403","type":"APC"}],"standard_charges":[{"minimum":5.25,"maximum":5.25,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, nitroglycerin, 5 mg","code_information":[{"code":"9404","type":"APC"}],"standard_charges":[{"minimum":5.25,"maximum":5.25,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Piflu f-18, dia 1 millicurie","code_information":[{"code":"9430","type":"APC"}],"standard_charges":[{"minimum":1273.43,"maximum":18566.41,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6179.0,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9965.71,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7499.61,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6523.21,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8778.49,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18566.41,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6545.92,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6524.66,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6527.97,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6528.37,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5251.61,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6525.31,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6218.7,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6525.31,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5313.37,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7549.53,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1273.43,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5585.55,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6179.0,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6212.82,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7517.37,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7517.37,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6332.77,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6872.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj anifrolumab-fnia 1mg","code_information":[{"code":"9434","type":"APC"}],"standard_charges":[{"minimum":5284.53,"maximum":5284.53,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5284.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj ferric carboxymaltos 1mg","code_information":[{"code":"9441","type":"APC"}],"standard_charges":[{"minimum":1168.34,"maximum":2208.25,"setting":"outpatient","payers_information":[{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2208.25,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1168.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, nivolumab","code_information":[{"code":"9453","type":"APC"}],"standard_charges":[{"minimum":15429.88,"maximum":15429.88,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15429.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj., durvalumab, 10 mg","code_information":[{"code":"9492","type":"APC"}],"standard_charges":[{"minimum":12263.11,"maximum":12263.11,"setting":"outpatient","payers_information":[{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12263.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, ocrelizumab","code_information":[{"code":"9494","type":"APC"}],"standard_charges":[{"minimum":2.94,"maximum":36359.94,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2.94,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34880.49,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36359.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"9501","type":"APC"}],"standard_charges":[{"minimum":1508.06,"maximum":3519.84,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1671.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1508.06,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3519.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"RBC leukocytes reduced","code_information":[{"code":"9512","type":"APC"}],"standard_charges":[{"minimum":733.99,"maximum":2196.02,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2196.02,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":733.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"minimum":7.53,"maximum":3618.37,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90.56,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33.44,"methodology":"other"},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":309.12,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26.69,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":477.83,"methodology":"other"},{"payer_name":"All Savers Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":80.78,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.88,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.17,"methodology":"other"},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":388.8,"methodology":"other"},{"payer_name":"Ar Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33.02,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":63.66,"methodology":"other"},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18.35,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":72.17,"methodology":"other"},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":149.54,"methodology":"other"},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135.2,"methodology":"other"},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.72,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30.39,"methodology":"other"},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19.16,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53.22,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.83,"methodology":"other"},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":149.40,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":235.0,"methodology":"other"},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":235.0,"methodology":"other"},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":183.68,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":188.0,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":190.42,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":89.46,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":264.88,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67.71,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.09,"methodology":"other"},{"payer_name":"Goldins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":597.91,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61.81,"methodology":"other"},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9.09,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.46,"methodology":"other"},{"payer_name":"Joplin Claims","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.51,"methodology":"other"},{"payer_name":"Kmap","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34.32,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.97,"methodology":"other"},{"payer_name":"Medben","plan_name":"Medben","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20.28,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38.45,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64.41,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33.74,"methodology":"other"},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3618.37,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7.53,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.12,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13.53,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29.91,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16.97,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28.04,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.77,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.19,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.3,"methodology":"other"},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16.91,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26.61,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.44,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26.61,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29.63,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40.50,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.16,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25.75,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25.82,"methodology":"other"},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21.88,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":437.72,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":562.32,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.28,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38.77,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33.63,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30.29,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":210.01,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13.64,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25.32,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68.26,"methodology":"other"},{"payer_name":"Tribal Member","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":164.32,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.24,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26.04,"methodology":"other"},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":143.42,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":860.52,"methodology":"other"},{"payer_name":"Uhc 30573","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.0,"methodology":"other"},{"payer_name":"Uhc 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":65.50,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.14,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.63,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.05,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29.62,"methodology":"other"},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34.06,"methodology":"other"},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.02,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.0,"methodology":"other"},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.63,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.9,"methodology":"other"},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.09,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.41,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30.76,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23.62,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34.38,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25.28,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"minimum":47.2,"maximum":940.85,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":424.52,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":141.39,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":147.65,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":106.42,"methodology":"other"},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":122.87,"methodology":"other"},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":258.01,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":231.75,"methodology":"other"},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":94.87,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.59,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":940.85,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":460.98,"methodology":"other"},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":296.16,"methodology":"other"},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.2,"methodology":"other"},{"payer_name":"Joplin Claims","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.92,"methodology":"other"},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":767.09,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.73,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61.17,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":204.88,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":130.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":337.85,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.02,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":161.32,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":131.66,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":493.45,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":246.73,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135.76,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":113.73,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":162.12,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":218.72,"methodology":"other"},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":436.6,"methodology":"other"},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.25,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":88.72,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.58,"methodology":"other"},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":606.69,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":522.10,"methodology":"other"},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68.81,"methodology":"other"},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":355.0,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114.32,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":169.0,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":169.0,"methodology":"other"},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":549.50,"methodology":"other"},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":108.18,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":320.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"minimum":73.75,"maximum":654.25,"setting":"outpatient","payers_information":[{"payer_name":"87726","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.3,"methodology":"other"},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.12,"methodology":"other"},{"payer_name":"Aarp United","plan_name":"Aarp United","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.84,"methodology":"other"},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":170.75,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna 14079","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":464.52,"methodology":"other"},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":464.52,"methodology":"other"},{"payer_name":"All Savers Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.3,"methodology":"other"},{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":144.76,"methodology":"other"},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":144.76,"methodology":"other"},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":172.2,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":172.2,"methodology":"other"},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":172.2,"methodology":"other"},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":172.2,"methodology":"other"},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.84,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135.61,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":172.2,"methodology":"other"},{"payer_name":"Cigna 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138.52,"methodology":"other"},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":150.77,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":150.77,"methodology":"other"},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":158.33,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":150.77,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.3,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":257.12,"methodology":"other"},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":244.84,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.3,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.3,"methodology":"other"},{"payer_name":"Goldins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.3,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":288.24,"methodology":"other"},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.84,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":91.65,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73.75,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":91.06,"methodology":"other"},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96.89,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.84,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96.23,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.84,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.84,"methodology":"other"},{"payer_name":"Medicare Allwell","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":98.81,"methodology":"other"},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":98.00,"methodology":"other"},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.84,"methodology":"other"},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.84,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.84,"methodology":"other"},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.84,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.84,"methodology":"other"},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.83,"methodology":"other"},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":98.17,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":453.42,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":464.52,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":199.58,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":167.52,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":162.73,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":153.52,"methodology":"other"},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":654.25,"methodology":"other"},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":98.08,"methodology":"other"},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":98.08,"methodology":"other"},{"payer_name":"Pan America Life","plan_name":"Pan America Life","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":425.26,"methodology":"other"},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":129.78,"methodology":"other"},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":129.78,"methodology":"other"},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.38,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":98.1,"methodology":"other"},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":259.33,"methodology":"other"},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":257.76,"methodology":"other"},{"payer_name":"Uhc 30573","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.3,"methodology":"other"},{"payer_name":"Uhc 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.3,"methodology":"other"},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.3,"methodology":"other"},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.84,"methodology":"other"},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":124.89,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.84,"methodology":"other"},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.3,"methodology":"other"},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.3,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.3,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.3,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.3,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.3,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.83,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pharmacy Services","code_information":[{"code":"N806","type":"APC"}],"standard_charges":[{"minimum":1.31,"maximum":1.31,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Observation, Other","code_information":[{"code":"N811","type":"APC"}],"standard_charges":[{"minimum":501.3,"maximum":982.5,"setting":"outpatient","payers_information":[{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":599.88,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":822.12,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":982.5,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":501.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"minimum":46.42,"maximum":444.84,"setting":"outpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49.11,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":159.71,"methodology":"other"},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":69.11,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87.77,"methodology":"other"},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":282.25,"methodology":"other"},{"payer_name":"Cignahp","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":132.28,"methodology":"other"},{"payer_name":"Commercial","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":301.06,"methodology":"other"},{"payer_name":"Cox Health Ins","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.17,"methodology":"other"},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":236.16,"methodology":"other"},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.71,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":158.45,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":120.79,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":444.84,"methodology":"other"},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":340.10,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":119.35,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.48,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":268.75,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.42,"methodology":"other"},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.48,"methodology":"other"},{"payer_name":"Tricare West","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.89,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":236.16,"methodology":"other"},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":235.25,"methodology":"other"},{"payer_name":"Unhcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":236.16,"methodology":"other"},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"minimum":1.58,"maximum":3260.95,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.92,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.34,"methodology":"other"},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1805.69,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":315.76,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3260.95,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1.58,"methodology":"other"},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":467.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Influenza Vaccines & Pneumococcal Pneumonia Vaccines","code_information":[{"code":"N903","type":"APC"}],"standard_charges":[{"minimum":5.25,"maximum":5.25,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"minimum":3.06,"maximum":3833.15,"setting":"outpatient","payers_information":[{"payer_name":"Ambetter Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2355.85,"methodology":"other"},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":532.25,"methodology":"other"},{"payer_name":"Geha Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3002.66,"methodology":"other"},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3.15,"methodology":"other"},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58.75,"methodology":"other"},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10.3,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3022.04,"methodology":"other"},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3068.26,"methodology":"other"},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2831.24,"methodology":"other"},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3520.4,"methodology":"other"},{"payer_name":"Missouri Home State","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":255.9,"methodology":"other"},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3833.15,"methodology":"other"},{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1230.3,"methodology":"other"},{"payer_name":"Uhc Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1960.0,"methodology":"other"},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":391.96,"methodology":"other"},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Non-covered Services","code_information":[{"code":"N999","type":"APC"}],"standard_charges":[{"minimum":6.99,"maximum":6.99,"setting":"outpatient","payers_information":[{"payer_name":"Mo Medicaid","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6.99,"methodology":"other"}],"billing_class":"facility"}]}],"modifier_information":[{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional","code":"76","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia","code":"74","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day","code":"GG","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"X-ray taken using computed radiography technology/cassette-based imaging","code":"FY","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes","code":"TB","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Positron emission tomography (pet) or pet/computed tomography (ct) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing","code":"PI","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Positron emission tomography (pet) or pet/computed tomography (ct) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treating physician determines that the pet study is needed to inform subsequent anti-tumor strategy","code":"PS","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke","code":"G0","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"87726","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Optum","plan_name":"Aarp Optum","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp United","plan_name":"Aarp United","description":"The modified price is presented in the standard charge value."},{"payer_name":"Administrative Concepts","plan_name":"Administrative Concepts","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna 14079","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna El Paso 981106 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"All Savers Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allstate Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Ambetter Of Sunflower Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Family Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Natl Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Republic Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Americas Choice Hlt 922043","plan_name":"Americas Choice Hlt 922043","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ar Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Fidelity Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bankers Life Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix R","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Fed Prefix Ycf","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Mo Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Out Of State Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Gold","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Pathway Silver","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bearskin Hl Clinic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Mgmt Joplin Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Epo Out Of Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Fed Basic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ks Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Mo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Open Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Pos And Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Secondary Only","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Traditional","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Benefits","plan_name":"Bmi Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Comm Col","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Fort Scott Community","plan_name":"Bmi Fort Scott Community","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Healthplans Comm","plan_name":"Bmi Healthplans Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bmi Mssu Athletes","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Fidelity","plan_name":"Christian Fidelity","description":"The modified price is presented in the standard charge value."},{"payer_name":"Christian Hlthcare Ministries","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Mi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Behavioral Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Chatt 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Connect Epo Oon","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthscope 188061","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hlth Care Apwu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cignahp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Combined Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Commercial","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cox Health Ins Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Crum  Forster","plan_name":"Crum  Forster","description":"The modified price is presented in the standard charge value."},{"payer_name":"Everest","plan_name":"Everest","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Agency","plan_name":"First Agency","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"First Health 2830 Comm","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fmh Benefits","plan_name":"Fmh Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Claims Mgmt","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fringe Benefit Group","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Medicare Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Geha Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Globe Life And Accid Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Golden Rule Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Goldins","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Grtwest Cigna Life Mo Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Guarantee Trust Life Comm Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Plans Inc","plan_name":"Health Plans Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthscope Uhc","plan_name":"Healthscope Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Mo","plan_name":"Healthy Blue Mo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Mcr Supplement","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Ppox 14635","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Img","plan_name":"Img","description":"The modified price is presented in the standard charge value."},{"payer_name":"Joplin Claims","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kmap","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lumico Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattan Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Manhattanlife Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mcr Uhc Dual Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben","plan_name":"Medben","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi Share","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica 30990 Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medica Behavioral Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ark Summit Community","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Blue Cross","plan_name":"Medicaid Arkansas Blue Cross","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Arkansas Total Claims","plan_name":"Medicaid Arkansas Total Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Cenpatico Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Kansas Cenpatico","plan_name":"Medicaid Kansas Cenpatico","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Sunflower State Hl","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Ks Uhc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Missouri Hlthnet","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Aetna","plan_name":"Medicaid Oklahoma Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Complete","plan_name":"Medicaid Oklahoma Complete","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Oklahoma Humana","plan_name":"Medicaid Oklahoma Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Other States","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Epo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Hmo Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Aetna Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Allwell Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Pffs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Humana Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Missouri","plan_name":"Medicare Missouri","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Nhc Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Optum Health","plan_name":"Medicare Optum Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Pphp Isnp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Replacement Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc","plan_name":"Medicare Uhc 30539","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc 30995","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ks","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Ok","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Uhc Dual Plan Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Wellcare Oklahoma","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medico Medicare Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Hlth 853921 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Healthy Blue","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Home State","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Missouri Unitedhealthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mo Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mutual Of Omaha Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Native Care Quapaw Tribe Memb","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Natl General Acc  Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal","plan_name":"Northeastern Tribal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Northeastern Tribal Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca Smc Serv Ctr Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Healthcare Auth","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oklahoma Medicaid","plan_name":"Oklahoma Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Old Surety Life Insurance Co","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pan America Life","plan_name":"Pan America Life","description":"The modified price is presented in the standard charge value."},{"payer_name":"Preferred One Uhc","plan_name":"Preferred One Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Psu Athletics","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice 25610 Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice Pos 25610 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rural Carrier Benefit Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Show Me Healthy Kids","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark 2942 Comm","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Starmark Aetna","plan_name":"Starmark Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"State Farm Ins Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Student Insurance","plan_name":"Student Insurance","description":"The modified price is presented in the standard charge value."},{"payer_name":"Transamerica Mcr Sup","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tribal Member","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Reg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare Mcr Supp West Region","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trivent Financial Admin","plan_name":"Trivent Financial Admin","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Health Benefits","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark/Luminare","plan_name":"Trustmark/Luminare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc","plan_name":"Uhc 30975","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30573","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc 740818","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Bindsurest","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Care Imp Mcr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Exchange Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Global 30526","plan_name":"Uhc Global 30526","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc New York 5230","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ny 1600","plan_name":"Uhc Ny 1600","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30884","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Plus 31375","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30555","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Ppo 30985","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 211762","plan_name":"Umr Uhc 211762","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838","plan_name":"Umr Uhc 2838","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 2838 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Core","plan_name":"Umr Uhc 30515 Core","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30515 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30518","plan_name":"Umr Uhc 30518","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530","plan_name":"Umr Uhc 30530","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30530 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30541 Ppo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc 30787","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc Shared 30783","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unhcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Am Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Usaa Life Ins Mcr Supp","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Visn 16","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vha Office Of Comm Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Web Tpa Mc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]}]}